Avtor/Urednik		Kos-Golja, Mojca
Naslov		Revmatološke manifestacije pri kroničnih vnetnih črevesnih boleznih - kdaj pomisliti nanje in kako voditi zdravljenje?
Prevedeni naslov		Rheumatic manifestations in chronic inflammatory enteropathic diseases - when to consider them and how to plan the treatment
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 40, št. Suppl 1
Leto izdaje		2001
Obseg		str. 37-40
Jezik		slo
Abstrakt		Chronic inflammatory enteropathic diseases, such as Crohn's disease and ulcerative colitis, are manifested by various rheumatic symptoms and syndromes. Enteropathic spondyloarthritides are a group of rheumatic diseases which can combine with inflammatory enteropathic diseases; they belong to a large group of seronegative spondyloarthritides. Peripheral arthritis, saeroiliitis and spondylitis are the most common rheumatological conditions, which can appear simultaneously or after the beginning of an inflammatory bowel disease, but rarely will rheumatic manifestations precede an enteropathic disease. The etiopathogenesis of enteropathic spondyloarthritides is not yet clear; several genes and environmental factors probably play an important role. Because of inflammatory changes in the enteric mucous membrane, which normally acts as a barrier to various bacteria, toxins and other substances, the local immune response is altered. In genetically predisposed persons, such changes can cause rheumatic and other extraintestinal manifestations: in patients with inflammatory enteropathic disease, the presence of the HLA-B27 antigen increases the risk of developing spondylitis, which is indistinguishable from idiopathic ankylosing spondylitis. Peripheral arthritis is usually less severe compared with rheumatoid arthritis, and transient - no permanent changes of joint structures appear. The treatment of enteropathic spondyloarthritides is primarily symptomatic. Non-steroidal anti-rheumatic drugs are used as analgesic and anti-inflammatory agents. The use of sulphasalazine is indicated especially in peripheral arthritis.
Izvleček		Pri kroničnih vnetnih črevesnih boleznih kot sta Crohnova bolezen in ulcerozni kolitis, se pojavljajo različni revmatski simptomi in sindromi. Enteropatični spondiloartritisi so skupina revmatičnih bolezni, ki jih uvrščamo med serološko negativne spondiloartritise. Periferni artritisi, sakroiliitis in spondilitis so najpogostejše revmatične bolezni, ki se pojavijo istočasno ali po začetku vnetne črevesne bolezni, redko pred njo. Etiopatogeneza enteropatičnih spondiloartritisov ni povsem jasna; verjetno so v njihov nastanek vpleteni različni geni in zunanji dejavniki. Zaradi vnetnih sprememb črevesne sluznice, ki služi v normalnih pogojih kot zapora pred vdorom raznih bakterij, toksinov in drugih snovi, se spremeni lokalni imunski odziv. Te spremembe črevesne sluznice lahko pri genetsko dojemljivih osebah povzročijo revmatične in druge mane zunajčrevesne izraženosti. Bolniki z vnetno črevesno boleznijo, ki so nosilci antigena HLA-B27, so še bolj dovzetni za nastanek spondilitisa, ki se ne loči od idiopatskega ankilozirajočega spondilitisa. Periferni artritisi pri vnetnih enteropatijah so v primerjavi z revmatoidnim artritisom bolj blagi, prehodni in ne zapuščajo trajnih posledic. Zdravljenje enteropatičnih spondiloartritisov je v prvi vrsti simptomatsko. Uporabljamo predvsem nesteroidne antirevmatike, pri perifernih artritisih je indicirano tudi zdravljenje s sulfasalazinom.
Deskriptorji		INFLAMMATORY BOWEL DISEASES ARTHRITIS, RHEUMATOID SPONDYLITIS, ANKYLOSING SACROILIAC JOINT