Rheumatic as Gastrointestinal

The particular focus here is antibiotic therapy, proven safe and effective in NIH-sponsored clinical trials. Thousands of patients have reported successfully using antibiotics for conditions including rheumatoid arthritis, scleroderma, juvenile rheumatoid arthritis, lupus, dermatomyositis, ankylosing spondylitis, Lyme disease, Reiter's syndrome, mixed connective tissue disease, fibromyalgia and psoriatic arthritis. Results of an international survey of patients documented dramatic results including relief of pain, the lessening of swollen joints and an overall successful return of quality of life.

The gut has multiple mechanisms to regulate the efficient absorption of nutrients while excluding bacterial and dietary antigens. Impairment of the gastrointestinal barrier function can be observed in several diseases including inflammatory bowel disease (IBD) and other spondyloarthropathies, and this defect may play a role in the pathogenesis of arthropathies.

Illeocolonoscopy and multiple biopsies were carried out in 96 patients with seronegative spondyloarthropathy, 17 patients with osteoarthritis taking nonsteroidal anti-inflammatory drugs (NSAIDs), and 19 patients with chronic abdominal discomfort. Inflammatory gut lesions were detected in two thirds of the patients with spondyloarthropathy, 12.5% of patients with osteoarthritis, and 16% of patients with abdominal discomfort. More recently, an Italian study confirmed microscopical mucosal inflammation on biopsy in 15 people with psoriatic arthritis but without bowel symptoms, 6 of whom had normal appearing mucosa by colonoscopy.

Because the results obtained from such studies are entirely dependent on normal gastric emptying, normal renal function, and an accurate urine collection, they should be interpreted carefully. Also, the results may be altered by possible effect of the NSAIDs on prostaglandin synthesis and gut permeability.

Most recently, Salmi et al concluded that different leukocyte populations derived from inflamed gut of patients with IBD bind avidly to synovial vessels using a distinct repertoire of adhesion molecules, suggesting that their recirculation may contribute to the development of reactive arthritis in inflammatory bowel diseases . This study is the first experimental support of the homing of lymphocytes from the gut mucosa to joint tissue in enteropathic arthritis.