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

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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