Colonic Inertia Symptoms

Arthritis of inflammatory colonic disease are the joint damage that may be peripheral inflammatory and / or axial and which may occur in association with colonic disease (ulcerative colitis / Crohn disease, acute enterocolitis microbial gluten enteropathy, colonic bypass, colitis, collagen, lymphocytic colitis). The possibility that certain food antigens to be absorbed unchanged and to generate immune responses is suggested by clinical observation mainly on breast-fed children, who make colic more frequently when the mother consuming cow's milk. Dietary and socioeconomic factors seem to play an important role in these diseases. Tobacco seems to be protective in ulcerative colitis but also is an aggravating factor in Crohn's disease by immunosuppression effect or influence on the protective mucin colonic mucosa. Both Crohn's disease and ulcerative colitis exist in similar distribution of age (1014 years and 60-70 years), meeting in both sexes but is more common Crohn's disease in women.

One is the involvement of genetic determinants. The genetic factor is the HLA B27 is associated with impaired axial spine.Type I peripheral arthritis is associated with HLA B27, B35 and DR1 and peripheral arthritis associated with HLA type B44 II. Triggers joint inflammation (arthritis) of colonic disease is unknown but most likely involved different germs. In Crohn's disease and mycobacteria were isolated in ulcerative colitis are present signs that a particular approach as ulcerative colitis were found in serum antibodies to Escherichia coli. There have also been involved citomegalovirusuri or Shigella, but not isolated from the colonic wall to determine if the infection is causing or is a superadd. Onset or relapse under emotional stress raised the question of etiologic role of psychological factors but more likely they are secondary.Infection associated with colonicinflammation cauzeza colonic permeability increase for some microbial antigens in the diet lead to loss of tolerance to bacterial flora of their own, forming circulating immune complexes, antigens in the joint and increase storage joint inflammation (arthritis). Crohn's disease have differences in terms of pathology compared with ulcerative colitis. In ulcerative colitis there is inflammation in the colon mucosa (hyperemia, ulcers, bleeding) uniform, continuous and rectum are often interested in Crohn's disease is more frequently affected ileum, which is thickened. Because inflammation occurs after loss of epithelial cells leading to ulceration. Chronic inflammation in Crohn's disease affects all layers of the colonic wall and mesenteric lymph regional interest for including so over time the intestine is thickened, narrow lumen until obstruction. Lesions are staple in Crohn's disease, in approximately 50% of the rectum is not affected. Symptoms Arthritis may be associated with some colonic diseases, pancreatitis, acute hepatitis, chronic active hepatitis, acute enteric infections. Intestine is, on the other hand, often interested in some rheumaticcolonic diseasesuch as Behcet's disease, Reiter syndrome. Extraarticular manifestations in inflammatory bowel disease are found in 25% of cases. Those with severe inflammatory bowel disease presents as joint manifestations: inflammatory arthritis, ankylosing spondylitis and sacroileita. In Crohn's disease are found peripheral arthritis but is recorded and an increased prevalence of ankylosing spondylitis. Arthritis of inflammatory bowel disease usually begins with systemic manifestations, overall influences weight loss, fever, abdominal pain, diarrhea. In ulcerative colitis diarrhea may be bloody, evolution is intermittent in flare-ups or chronic. In Crohn's disease due to the extension variable clinical lesions is diverse - from the appearance of acute sudden onset, fever, abdominal pain suggesting appendicitis chronic forms living dominated compared with the overall digestive signs. This joint manifestations is found in different proportions in inflammatory bowel disease. Peripheral arthritis is seen in 17-20% of patients with HLA B27 is not asocisata.Arthritis Type I occurs in 5% of patients and reflect colonic inflammation activity.This condition may be oligoarticular, monoarticulara, acute, asymmetrical, migratory. Usually large joints are affected leg (often knee), appears early and is associated with erythema nodosum and uveitis. Arthritis Type II is found in 3-4% of patients, polyarticular, symmetrical. This type of arthritis cause joint deformities, affecting the metacarpophalangeal joints frequently.Large joints are rarely involved knees, ankles, elbows, shoulders, fists, proximal interphalangeal joints and metatarsophalangeal. Joint damage is present in both types of arthritis, inflammation bowel disease reflects not. Sacroileita (inflammation of the sacroiliac joints) occurs in 4-8% of asymptomatic cases and about 1-26% ankylosing spondylitis. Arthritis acute colonic parallel flashes, occurred early in the course of inflammatory bowel disease, is limited in scope and is manifested by swelling, redness, local heat and cause destruction and osteoarticular deformities. Both Crohn's disease and ulcerative colitis are frequently associated with spondilartrita. Spondylitis in inflammatory bowel

disease do not differ from idiopathic in terms of onset and clinical evolution. Frequent association with arthritis and scapulohumeral coxofemurala is increased in patients with ankylosing spondylitis. Other possible joint manifestations are common among digital clubbing in Crohn's disease and that disappears after surgical treatment of disease through inactivity osteoporosis, malabsorption and / or after treatment with corticosteroids, osteomalacia in malabsorption. Extraarticular manifestations in inflammatory bowel disease are: - Eye damage - often acute anterior uveitis is present, which is unilateral, usually transient and recurrent. Anterior uveitis is frequently associated with severe axial and HLA B27. - Skin and mucosal lesions - erythema nodosum is seen in those with severe type I peroferica - Amyloidosis - rare, about 1% of patients, 25% were found postmortem. Tests Blood tests conducted reveals inflammatory syndrome (elevated ESR, positive C-reactive protein), anemia characteristic of chronic disease, leukocytosis, thrombocytosis (700000-1000000/mm3). Synovial fluid analysis often highlights an increased number of leukocytes (1500-5000/mm3) with predominant polymorphonuclear. Immunological exploration highlights the absence of RF and antinuclear antibodies (ANA) and the presence of HLA B27. Radiological examination emphasizes the inflammatory axial (spine damage), sacroileita symmetric (inflammation of the sacroiliac joints) bilateral and present sindesmofitelor typical spine (column layout is the "column of bamboo"). The peripheral arthritis of the joints involved radiological examination rarely reveals destructive arthropathy of the hip and small joints of the hands and feet, sometimes entezita. Diagnosis and Treatment Diagnosis of rheumatic manifestations and their framing raise special problems when inflammatory bowel disease is unknown. Positive diagnosis is established after history and laboratory explorations. This arthritis must first great migration of rheumatic fever. If monoarticulare damage (affecting a single joint) to make problems of differential diagnosis of gout, pseudogout, Reiter's syndrome and reactive arthritis onset diarrhea. In chronic forms of arthritis with joint deformities that accompany inflammatory bowel colonic disease with rheumatoid arthritis differential diagnosis is difficult, especially when joint manifestations does not correlate with the bowel or sometimes when rheumatoid arthritis is seronegative. Treatment Specific treatment is with anti-inflammatory, used for axial and peripheral joint pains.Sometimes anti-inflammatory drugs can exacerbate especially colonic symptoms, such as in some cases be used only if symptoms and signs of inflammatory bowel disease do not occur or worsen. Intra-articular corticosteroid therapy may be administered intravenously and in some cases, especially for digestive distress in the form of enema. Remission treatment including joint pain is sulphasalazine (mesalazine, olsalazina), azathioprine or 6mercaptopurine, methotrexate, cyclosporin A, anti-TNF biological therapy. For Type II joint damage and impaired biological axial anti TNF therapy is recommended: etanercept and infliximab. The axial impairment and physical therapy is beneficial.

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