Gut short-circuit arthritis dermatitis syndrome
Introduction
Brief introduction of intestinal short circuit arthritis dermatitis syndrome Intestinal short-circuit surgery (jejunum ileum anastomosis) is a common treatment for morbid obesity, but may cause arthritis-dermatitis syndrome, sometimes complicated by kidney, liver and blood system diseases. Arthritis symptoms appear in 20% to 80% of cases 2 to 30 months after surgery. This arthritis is multi-joint symmetry and migratory, which can affect the upper limbs and the lower limbs. One-fourth of the patients were chronically affected and could not predict the duration of arthritis. There was no correlation between joint symptoms and abnormal bowel movements. No radiological abnormalities or erosions are seen; ankle and spine involvement are uncommon, and 66% to 80% of patients have various skin abnormalities, nodular erythema, macules, papule-like rash, pus Herpes-like rash, urticaria and nodular dermatitis have been reported. Other clinical manifestations include Raynaud's phenomenon, paresthesia, pericarditis, pleurisy, glomerulonephritis, retinal vasculitis and superficial thrombophlebitis. Since 1952, intestinal short circuit has been used as a treatment for weight loss. After 11 years, this therapy has been found to have achieved weight loss goals, but it often causes complications including malabsorption and joint symptoms. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: purpura erythema
Cause
Intestinal short circuit arthritis dermatitis syndrome etiology
(1) Causes of the disease
There is a history of surgery using intestinal short circuit surgery (jejunum ileum anastomosis) as a weight loss.
(two) pathogenesis
The pathogenesis includes bacterial overgrowth and mucosal changes in the intestinal tract, which appears to be mediated by immunity, because cryoprecipitates and other circulating complexes containing immunoglobulins, complements, bacterial antibodies and antigens can be found in the serum, intestines Overgrowth of blind cockroaches can cause excessive antigenic stimulation.
Prevention
Intestinal short circuit arthritis dermatitis prevention
Avoid intestinal short circuit surgery (jejunum ileum anastomosis) as a weight loss, only surgical reconstruction of the short circuit segment of the intestine can completely alleviate all symptoms, and this may be necessary in refractory cases, intestinal re-anastomosis is the most effective Therapy.
Complication
Intestinal short circuit arthritis dermatitis syndrome complications Complications
80% of patients have skin brown spots, cyanosis, small pustules or nodular erythematous skin lesions and arthritis, skin biopsy showed mild microvascular inflammation, 1/3 of patients with Raynaud, a small number of patients Can be complicated by pericarditis, pleurisy, glomerulonephritis, retinal vasculitis and superficial thrombophlebitis.
Symptom
Intestinal short circuit arthritis dermatitis symptoms common symptoms pustular bone sclerosis back pain nodules
The incidence of this syndrome is 8% to 36%. Arthritis often occurs within one year after jejunal fistula. It lasts for one week to several months or even years. The incidence of women is more than that of men, which is three times that of men. Involved in knee, ankle, finger, wrist and shoulder joints, pain is obvious, but separated from objective body weight, joint bone erosion is rare, often have back pain, ankle joint imaging changes, evidence of cartilage sclerosis, rarely In the performance of arthritis, 80% of patients have skin brown spots, cyanosis, small pustules or nodular erythematous skin lesions and arthritis, skin biopsy showed mild microangiitis, one third of patients have Raynaud phenomenon, rarely fever.
Examine
Intestinal short circuit arthritis dermatitis syndrome examination
Acute inflammatory phase, erythrocyte sedimentation rate, elevated white blood cells, increased c-reactive protein, bacteriological examination and serological examination help to detect the pathogen of primary infection, serum rheumatoid factor, anti-nuclear antibody negative, HLA-B27 positive rate not sure.
Radiological abnormalities or erosions are not seen; ankle and spine involvement are not common.
Diagnosis
Diagnosis and differential diagnosis of intestinal short circuit arthritis syndrome
According to the clinical history and performance, the characteristics of skin lesions and the characteristics of laboratory tests can be diagnosed.
There are complicated pericarditis, pleurisy, glomerulonephritis, retinal vasculitis and superficial thrombophlebitis, skin brown spots, purpura, small pustules or nodular erythematous skin lesions should be differentiated from the above diseases.
