LETTER
Arthritis and Collagenous Colitis
James M. Sowa, MD
1 August 1994 | Volume 121 Issue 3 | Page 237
TO THE EDITOR:
Castanet and colleagues [1] described a patient with collagenous colitis, discoid lupus, and nonerosive seronegative inflammatory polyarthritis. Although the arthritis was symmetric and involved the metacarpals, all other joints (elbows, shoulders, and knees) were large. It is conceivable that this patient had an enteropathic arthritis associated with collagenous colitis, as described by Roubenoff and colleagues [2].
The authors cite Giardiello and associates [3], yet none of their seven patients had arthritis (although three had antinuclear antibodies, and one also had rheumatoid factor). Similarly, none of the six patients of Kingham and colleagues [4] had a rheumatic disease. Scleroderma was not discussed.
Two reports of rheumatoid disease associated with collagenous colitis are of interest. The patient of Farah and coworkers [5] had her first diarrhea in the setting of gold toxicity and, although it "settled after gold withdrawal," mild recurrences continued for almost a year. After 2 years without symptoms, collagenous colitis recurred [5]. Lavabre and colleagues [6] recently described a woman with rheumatoid disease who was receiving parenteral gold, corticosteroids, and salicylates and who developed collagenous colitis.
Colitis is a known, albeit rare, toxicity of parenteral gold. Did the patients in the older reports have collagenous colitis, or is gold a toxin that might rarely cause collagenous colitis? Speculation on the cause of collagenous colitis has included unknown toxins [3-5].
1. Castanet J, Lacour JP, Ortonne JP. Arthritis, collagenous colitis, and discoid lupus (Letter). Ann Intern Med. 1994; 120:89-90.
2. Roubenoff R, Ratain J, Giardiello F, Hochberg M, Bias W, Lazenby A, et al. Collagenous colitis, enteropathic arthritis and autoimmune diseases: results of a patient survey. J Rheumatol. 1989; 16:1229-32.
3. Giardiello FM, Bayless TM, Jessurun J, Hamilton SR, Yardley JH. Collagenous colitis: physiologic and histopathologic studies in seven patients. Ann Intern Med. 1987; 106:46-9.
4. Kingham JG, Levison DA, Morson BC, Dawson AM. Collagenous colitis. Gut. 1986; 27:570-7.
5. Farah DA, Mills PR, Lee FD, McLay A, Russell RI. Collagenous colitis: possible response to sulfasalazine and local steroid therapy. Gastroenterology. 1985; 88:792-7.
6. Lavabre C, Clerc D, Durandin M, Berge E, Bisson M. Rheumatoid arthritis and collagenous colitis. Report of a case (Letter). Rev Rhum. 1993; 60:225-6.
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