Rheumatic Disorders Associated with Pouchitis Lymphocytic Colitis and Collagenous Colitis

What rheumatic disorders are associated with pouchitis, lymphocytic colitis (LC), and collagenous colitis (CC)? 

  • Pouchitis is inflammation of the ileal pouch created following colectomy for UC. It occurs in up to 40% to 60% of patients having this surgery. Patients present with watery or bloody diarrhea. Some develop arthritic manifestations. Treatment includes metronidazole and ciprofloxacin. Surgical revision may be necessary in treatment-resistant cases.
  • Rheumatic Disorders Associated with Pouchitis, Lymphocytic Colitis, and Collagenous Colitis
PouchitisLCCC
IBD-like peripheral inflammatory arthritisYesYesYes
Rheumatoid arthritisNoYesYes
Ankylosing spondylitis *NoNoNo
Thyroiditis or other autoimmune diseaseNoYesYes

CC, Collagenous colitis; IBD, inflammatory bowel disease; LC, lymphocytic colitis.

* Up to 60% of patients with ankylosing spondylitis have asymptomatic Crohn-like lesions on right-sided colon biopsies. However, only 4% to 5% will evolve into overt inflammatory bowel disease.

  • Microscopic colitis includes both LC and CC. Patients present with watery diarrhea and may develop arthritic manifestations (10%-20%) or autoimmune thyroiditis.
  • Patients older than 65 years (80%) and females (60%) are most commonly affected.
  • The diagnosis can only be made by tissue histologic examination obtained by colonoscopy. 
  • Budesonide is effective for inducing and maintaining clinical and histologic remission for CC and LC, and loperamide may ameliorate diarrhea .
  • Evidence for benefit of bismuth subsalicylate and mesalamine with or without cholestyramine for treatment of CC or LC is weak.
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