Shiraz Emedical Journal
Volume:3 Issue: 1, Jan 2002

Rheumatologic diseases are multisystem disorders which can involve any part of the gastrointestinal tract, hepatobiliary system and pancreas. Gastrointestinal manifestation may be the initial presentation of these disorders but it may also be the complication of treatment. Gastrointestinal complications are one of the major causes of morbidity and occasionally mortality especially if they are not diagnosed and treated at proper time. The gastrointestinal manifestations of thirteen rheumatologic disorders are presented here in alphabetic order.

A 67 lady, a known case of diabetes mellitus (type II), hypertension and IHD with coronary artery bypass grafting three years ago, referred due to hypotension, ventricular tachycardia and cardiopulmonary arrest. After resuscitation, she admitted in CCU and there, developed atrial fibrillation, which was successfully treated with cardioversion. Later, She developed abdominal pain that was associated with renal function deterioration. She was diagnosed as a case of bowel gangrene and was treated.

Homocystine is an amino acid, which is known for its congenitally acquired disease, Homocystinurea. Researchers have proposed that elevated plasma Homocystine may be associated with atherosclerosis. Patients with mild to moderate hyperhomocytinemia (seen in 5-7%of population) may be asymptomatic until third and forth decade that they may refer with coronary artery disease or recurrent arterial or venous thrombosis. Sever hyperhomocytinemia is relatively rare and is usually seen as homocystinurea. Normal plasma level of Homocystine is 5 - 15μmol/l (higher in men than premenopausal women). Causes of hyperhomocystinemia include: 1- enzymatic defects (Cystathione ß-synthase deficiency (the most common enzymatic defect), MTHFR deficiency, Methionine synthase deficiency), 2- dietary deficiency (folate, Vit B12, Vit B6) and 3- other causes (renal failure, liver disorders, hypothyroidism, malignancy including breast, ovarian or pancreatic cancers and drugs (such as methotrexate, trimetoprim, cholestyramine, colestipole, phenytion, carbamazepine, niacin, theophylin, cyclosporine and fibric acid derivatives). Treatment of hyperhomocysteinemia is vitamin supplementation and nutritional intervention.

Renal involvement is a major cause of morbidity and mortality in SLE. Some authors suggest that renal biopsy should be performed on all patients with SLE and morphological findings be used as a guide for therapy and prognosis. Recent cumulative evidence indicates that presence of the following conditions at the time of biopsy is associated with increased risk for renal failure: young age (<23 years) increased serum creatinine level, diffuse proliferative lesions (WHO classification class IV) and a high chronicity index on renal histologic analysis. This article also reviews the lupus nephritis