inflammatory bowel disease arthritis associated scleritis
Introduction
Introduction to scleritis associated with inflammatory bowel disease Inflammatory bowel disease associated with scleritis is Crohn's disease (CD) and ulcerative colon disease (UC). It is a generalized chronic inflammatory bowel disease, which is distinct from the cause. Inflammatory bowel disease can be associated with peripheral arthritis and spinal lesions. CD is a chronic, focal, asymmetrical, and gastrointestinal granulomatous inflammation that can occur in any part of the digestive tract, most often involved. The site is the terminal ileum and the cecum. UC is a chronic superficial inflammation that occurs in the diffuse, continuous mucosal and submucosal layers of the colon, and is more common in the rectum and sigmoid colon. basic knowledge The proportion of illness: the incidence rate is about 0.002%-0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: conjunctivitis retinal detachment orbital pseudotumor retrobulbar optic neuritis optic discitis orbital cellulitis
Cause
Causes of scleritis associated with inflammatory bowel disease
(1) Causes of the disease
Lack of the exact cause is the gap in understanding the pathogenesis of IBD. It is currently agreed that the pathogenesis of the two diseases involves immune abnormalities, which are autoimmune diseases, or allergic reactions and genetic factors, infections, neuropsychiatric factors, etc. The status is still difficult to be sure.
(two) pathogenesis
The accepted view is that IBD has a "down regulation" barrier that affects the ability of the gastrointestinal tract to distinguish between foreign and autoantigens, and/or affects the gastrointestinal mucosal immune response disorder. Anti-colon antibodies are present in the patient's serum, which respond to autologous and allogeneic colonic epithelial cells. About half of the patients have anti-colorectal antibodies or circulating immune complexes (CIC) in the serum, which causes colonic mucosal damage when the patient's tolerance is reduced. The patient's circulating lymphocytes have a cytotoxic effect on the autologous or allogeneic colonic epithelium, activate K cells to release lymphokines, and play a killing effect. Both diseases have extraintestinal damage, such as arthritis, uveitis, and glucocorticoids. Hormones can alleviate the condition, which indicates that the occurrence of IBD can be related to autoimmune reactions.
During the active period of IBD, eosinophils increased, mast cell granules and histamine increased in the intestinal mucosa, and the kallikrein-kinin system of endothelial cells was activated, causing microcirculation changes, resulting in increased vascular permeability. Intestinal wall congestion and edema, smooth muscle spasm, mucosal erosion and ulcers and other diseases.
The clinical manifestations of IBD are similar to pathological changes and intestinal infectious diseases, but pathogenic pathogens have not yet been identified. It has been suggested that neuropsychiatric factors are the etiology or predisposing factors of IBD, but clinical data indicate that IBD has a history of mental disorders or trauma. It is no more common than the general population.
Prevention
Inflammatory bowel disease associated with scleritis prevention
Pay more attention to living habits, prevent diseases, and promptly find timely treatment.
Complication
Complications of inflammatory bowel disease associated with scleritis Complications conjunctivitis retinal detachment orbital pseudotumor posterior optic neuritis optic discitis orbital cellulitis
Uncommon conjunctivitis, macular edema, serous retinal detachment, choroidal infiltration, orbital pseudotumor, extraocular muscle paralysis, retrobulbar optic neuritis, optic discitis, orbital cellulitis and extraocular myositis.
Symptom
Inflammatory bowel disease associated with scleritis symptoms Common symptoms Gastrointestinal symptoms Scleral outer inflammation Dehydration Osteoporosis Liver dysfunction
1. Eye performance: According to reports, the incidence of ocular disease in inflammatory bowel disease is 1.9% to 11.8%. The most common ocular manifestations are scleral inflammation, anterior uveitis, keratitis and scleritis. CDs or UC with arthritis and other extraintestinal lesions such as anemia, skin damage, liver disease, and oral ulcers are more susceptible to eye diseases, such as in patients with CD, patients with colitis or ileitis, and patients with only small bowel disease It is more prone to eye diseases. Eye diseases can occur before enteropathy, but most of them occur when colitis is worse. Effective bowel treatment can improve the prognosis of eye and systemic diseases. Therefore, patients with signs of eye and gastrointestinal symptoms must To determine the nature of the gastrointestinal disease, the ophthalmologist may be the first to diagnose IBD.
(1) Scleritis: It is reported that the incidence of scleritis in IBD is 2.06% to 9.67%. Patients with extraintestinal lesions have more common scleritis than patients without extraintestinal lesions. Scleritis can occur before enteropathy. However, it is common to occur in a few years after the occurrence of enteropathy, especially in the active period of enteropathy. IBD scleritis is prone to recurrence, and various types of scleritis including necrotic anterior scleritis may occur. According to clinical observation, the sclera is found. The occurrence of inflammation and scleral inflammation is not associated with UC, so whether or not these eye diseases occur is one of the distinguishing points for distinguishing between CD and UC.
(2) Scleral outer inflammation: IBD occurs in the common scleral inflammation, UC appears scleral outer inflammation is an excellent evidence to change the diagnosis to CD, because many years of clinical observations, scleral inflammation is only related to CD, although Scleral laminitis can occur before enteropathy, but it occurs more often after several years of bowel disease, especially during the progression of intestinal disease. It is more common in patients with IBD who have arthritis and other extraintestinal manifestations. .
(3) anterior uveitis: usually anterior uveitis is recurrent and non-granulomatous, accompanied by white fine-grained KP, moderate anterior chamber cell exudation, can occur at any time of intestinal disease, and joints Inflammation, especially the appearance of spondylitis, is closely related. In the differential diagnosis of anterior uveitis, IBD must be considered. IBD keratitis is especially prone to occur in patients with CD, which is characterized by acute inflammation on the edge of the cornea. Subcutaneous small round gray infiltration, or scarring caused subcortical nodular speckle at the edge of the cornea.
2. Non-eye manifestations: The most common gastrointestinal and joint lesions, gastrointestinal symptoms of CD patients have palsy, constipation, umbilical cord caused by partial or complete intestinal obstruction, 1/4 colic in the lower right abdomen, And accompanied by diarrhea, nausea, vomiting, fever, loss of appetite and weight loss, if the ulcer lesions perforated to the extraintestinal tissues or organs, can form a fistula, UC patients for the lower abdomen or lower left 1/4 abdominal pain, lighter, Pain-consciousness--the law of post-surgical remission, due to inflammatory stimuli, increased intestinal peristalsis and intestinal water, sodium absorption disorders, recurrent mucus peptic diarrhea that can produce dehydration and electrolyte imbalance.
Peripheral arthritis of the two diseases can occur or occur simultaneously before the onset of colitis in the period of 6 months to several years after the onset of intestinal disease. The general acute attack, often in an asymmetrical form, invades one or several large joints. The most commonly affected are knees, ankles and other weight-bearing joints, showing swelling, erythema, synovial fluid analysis is inflammatory, usually can be cured within a few weeks, leaving no sequelae, other joints that may invade have interphalangeal, elbow , shoulder and wrist joints, arthritis often occurs in patients with severe intestinal inflammation, a wide range of patients, treatment of intestinal inflammation, generally effective for arthritis, with the recovery of intestinal lesions function, arthritis appears in UC patients invading the colon are more common than isolated rectal lesions. CD invasion of the colon is more common than simple intestinal lesions. This arthritis does not damage the joints and is negative for rheumatoid factor (RF).
Skin mucosal lesions include oral ulcers found on CD, inflammatory skin disorders of IBD, such as gangrenous pyoderma and nodular erythema, associated with the activity of colonic lesions, sometimes skin lesions can appear before the symptoms of colonitis, nodules Sexual erythema is painful, sensitive skin erythema or purple nodules, most common in the legs, lesions are multiple, can occur in any limb, mild trauma can induce the disease, gangrenous pyoderma is more serious, can Necrotic ulcers appear, sometimes the course of the disease is not consistent with intestinal inflammation. Typical lesions occur in the lower limbs, but can also be found in any part of the body, occasionally in the surgical incision.
Other systemic manifestations of the patient, including anemia caused by blood loss or loss of protein, liver and biliary complications (such as gallstones of bile salt malabsorption, secondary malnutrition, glucocorticoid therapy or supplementation from deep vein high nutrient solution) More carbohydrate-induced hepatic steatosis, cholangitis and liver dysfunction), thrombophlebitis, etc., genitourinary abnormalities such as kidney stones are a common manifestation of IBD, caused by the combination of oxalate and calcium oxalate due to steatorrhea The fistula formed by CD often has bladder spasm, mechanical compression of inflammatory mass causes ureteral obstruction, etc., and IBD patients may also develop metabolic bone diseases such as osteoporosis and osteomalacia.
Examine
Examination of scleritis associated with inflammatory bowel disease
1. IBD can have anemia, white blood cells rise, ESR increases, and RF and anti-nuclear antibodies (ANA) are negative.
2. Pathological examination: It is not suitable for biopsy of skin and mucosal lesions in this disease, otherwise it may cause local skin or mucosal damage and ulcer formation. The above lesions are mostly caused by small vasculitis.
3. Radiological examination: The affected joints only show signs of mild destruction, such as cyst-like changes, narrowing of the joint cavity and bone erosion. The characteristic changes of the intestinal X-rays disappeared, and the affected intestinal mucosa was brush-like. Or small serrated edges, large ulcers and fake polyps.
4. Clinical digestive endoscopy: It can confirm the pathological changes of the digestive tract mucosa, estimate the condition, rectal examination reveals mucosal edema, becomes brittle, ulcer and is accompanied by mucopurulent discharge.
Diagnosis
Diagnosis and diagnosis of scleritis associated with inflammatory bowel disease
IBD does not have a clinical endoscopic and histological feature that can be diagnosed with symptoms. Therefore, doctors must fully consider clinical data and disease progression.
CD diagnosis can be based on clinical symptoms and signs, combined with X-ray changes, such as intestinal stenosis and rapid jump zone, colonoscopy helps to diagnose the lesions involved in the colon, tissue biopsy can show through the wall Sexual inflammation and granuloma formation, exclusion of infection, parasites, neoplasms and other causes, patients with colitis manifestations can be diagnosed as UC, the current IBD disease taxonomy depends on clinical description, endoscopy and histology standards.
