Öz
Crohn hastalığı ve Behçet hastalığının
intestinal tutulumunun ayırıcı tanısı her zaman kolay olamamaktadır. Otuz üç
yaşında kadın hasta, ön planda yaygın eklem şikâyetleri ile romatoloji
polikliniğine başvurdu. Uzun süredir devam eden anemi ve gastrointestinal
yakınmalarının aydınlatılması aşamasında, endoskopide derin ülserler gözlendi.
Olgumuz; Behçet hastalığı intestinal tutulumu ve Crohn hastalığı ayırıcı tanısı
ayrıntılı değerlendirmelerle yapıldıktan sonra, “Enteropatik Artrit” tanısı
aldı. Eklem şikâyetleri ile başvuran hastalarda sistemik değerlendirmenin önemi
ve eklem tutulumunun karakterinin iyi analiz edilmesinin tanıya katkısı, bu
vaka ile beraber bir kez daha vurgulanmıştır. Bu derlemede aynı zamanda, Crohn
hastalığı ve Behçet hastalığı intestinal tutulumunun ayırıcı tanısı,
gastrointestinal, ekstra intestinal bulguları ve endoskopide gözlenen ülser
özellikleri açısından özetlenmiştir.
Anahtar Kelimeler
Crohn hastalığı Behçet hastalığı gastrointestinal özellikleri ekstra intestinal bulgular ülser özellikleri ayırıcı tanı
Kaynakça
- 1. Pellicera Z, Santiagob JM, Rodriguezb A, et al. Management of cutaneous disorders related to inflammatory bowel disease. Ann Gastroenterol 2012;25:21-36. 2. James DG. Behcet’s syndrome. N Engl J Med 1979;301:431-2. 3. Kaklamani VG, Vaiopoulos G, Kaklamanis PG. Behçet’s Disease. Semin Arthritis Rheum 1998;27:197-217. 4.Sakane T, Takeno M, Suzuki N, et al. Behçet’s disease. N Engl J Med 1999;341:1284-91. 5.Bayraktar Y, Ozaslan E, Van Thiel DH. Gastrointestinal manifestations of Behcet's disease. J Clin Gastroenterol. 2000;30:144-54. 6. Dilşen N, Koniçe M, Aral O, et al. Comparative study of the skin pathergy test with blunt and sharp needles in Behçet’s disease: confirmed specificity but decreased sensitivity with sharp needles. Ann Rheum Dis 1993;52:823-5. 7. Choi IJ, Kim JS, Cha SD, et al. Long-term clinical course and prognostic factors in intestinal Behçet's disease. Dis Colon Rectum 2000;43:692-700. 8. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69:1580-8. 9. Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of Spondyloarthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011;70:25-31. 10. Kim DH, Cheon JH. Intestinal Behçet’s Disease: A true inflammatory bowel disease or merely an intestinal complication of systemic vasculitis. Yonsei Med J 2016;57:22-32. 11. Orchard TR. Management of arthritis in patients with inflammatory bowel disease. Gastroenterol Hepatol 2012;8:327-9. 12. Arvikar SL, Fisher MC. Inflammatory bowel disease associated arthropathy. Curr Rev Musculoskelet Med 2011;4:123-31. 13. Grigg EL, Kane S, Katz S. Mimicry and deception in inflammatory bowel disease and intestinal Behçet disease. Gastroenterol Hepatol (NY) 2012;8:103-12. 14. Li J, Li P, Bai J, et al. Discriminating potential of extraintestinal systemic manifestations and colonoscopic features in Chinese patients with intestinal Behçet’s disease and Crohn’s disease. Chin Med J (Engl) 2015;128:233-8. 15. Lee SK, Kim BK, Kim TI, et al. Differential diagnosis of intestinal Behçet's disease and Crohn's disease by colonoscopic findings. Endoscopy 2009;41:9-16. 16. Jung YS, Cheon JH, Park SJ, et al. Long-term clinical outcomes of Crohn's disease and intestinal Behcet's disease. Inflamm Bowel Dis 2013;19:99-105.
Öz
The differential diagnosis of intestinal
involvement in Crohn’s disease and Behcet’s disease can be challenging. A
33-year-old female patient attended to the rheumatology outpatient clinic with
the complaint of widespread joint involvement. Deep ulcers were observed on the
endoscopy when long-lasting anemia and gastrointestinal complaints were evaluated.
The patient was diagnosed with “enteropathic arthritis” after being assessed
regarding intestinal involvement of Behcet’s disease and Crohn’s disease in
detail for differential diagnosis. In this review, the importance of systematic
evaluation of all disease characteristics and the benefit of analysis of the
character of joint involvement in patients with joint complaints were
emphasized. The differential diagnosis of intestinal involvement of Crohn’s
disease and Behcet’s disease is also summarized in terms of gastrointestinal
and extraintestinal findings and endoscopic ulcer characteristics.
Anahtar Kelimeler
Crohn’s disease Behcet’s disease gastrointestinal findings extraintestinal manifestations ulcer characteristics differential diagnosis
Kaynakça
- 1. Pellicera Z, Santiagob JM, Rodriguezb A, et al. Management of cutaneous disorders related to inflammatory bowel disease. Ann Gastroenterol 2012;25:21-36. 2. James DG. Behcet’s syndrome. N Engl J Med 1979;301:431-2. 3. Kaklamani VG, Vaiopoulos G, Kaklamanis PG. Behçet’s Disease. Semin Arthritis Rheum 1998;27:197-217. 4.Sakane T, Takeno M, Suzuki N, et al. Behçet’s disease. N Engl J Med 1999;341:1284-91. 5.Bayraktar Y, Ozaslan E, Van Thiel DH. Gastrointestinal manifestations of Behcet's disease. J Clin Gastroenterol. 2000;30:144-54. 6. Dilşen N, Koniçe M, Aral O, et al. Comparative study of the skin pathergy test with blunt and sharp needles in Behçet’s disease: confirmed specificity but decreased sensitivity with sharp needles. Ann Rheum Dis 1993;52:823-5. 7. Choi IJ, Kim JS, Cha SD, et al. Long-term clinical course and prognostic factors in intestinal Behçet's disease. Dis Colon Rectum 2000;43:692-700. 8. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69:1580-8. 9. Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of Spondyloarthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011;70:25-31. 10. Kim DH, Cheon JH. Intestinal Behçet’s Disease: A true inflammatory bowel disease or merely an intestinal complication of systemic vasculitis. Yonsei Med J 2016;57:22-32. 11. Orchard TR. Management of arthritis in patients with inflammatory bowel disease. Gastroenterol Hepatol 2012;8:327-9. 12. Arvikar SL, Fisher MC. Inflammatory bowel disease associated arthropathy. Curr Rev Musculoskelet Med 2011;4:123-31. 13. Grigg EL, Kane S, Katz S. Mimicry and deception in inflammatory bowel disease and intestinal Behçet disease. Gastroenterol Hepatol (NY) 2012;8:103-12. 14. Li J, Li P, Bai J, et al. Discriminating potential of extraintestinal systemic manifestations and colonoscopic features in Chinese patients with intestinal Behçet’s disease and Crohn’s disease. Chin Med J (Engl) 2015;128:233-8. 15. Lee SK, Kim BK, Kim TI, et al. Differential diagnosis of intestinal Behçet's disease and Crohn's disease by colonoscopic findings. Endoscopy 2009;41:9-16. 16. Jung YS, Cheon JH, Park SJ, et al. Long-term clinical outcomes of Crohn's disease and intestinal Behcet's disease. Inflamm Bowel Dis 2013;19:99-105.
Ayrıntılar
| Bölüm | Makaleler |
|---|---|
| Yazarlar | |
| Yayımlanma Tarihi | 29 Ağustos 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 16 Sayı: 2 |
test-5