Leaky gut, circulating immune complexes, arthralgia, and arthritis in IBD: coincidence or inevitability?

Most host-microbiota interactions occur within the intestinal barrier, which is essential for separating the intestinal epithelium from toxins, microorganisms, and antigens in the gut lumen. Gut inflammation allows pathogenic bacteria to enter the blood stream, forming immune complexes which may deposit on organs. Despite increased circulating immune complexes (CICs) in patients with inflammatory bowel disease (IBD) and discussions among IBD experts regarding their potential pathogenic role in extra-intestinal manifestations, this phenomenon is overlooked because definitive evidence demonstrating CIC-induced extra-intestinal manifestations in IBD animal models is lacking. However, clinical observations of elevated CICs in newly diagnosed, untreated patients with IBD have reignited research into their potential pathogenic implications. Musculoskeletal symptoms are the most prevalent extra-intestinal IBD manifestations. CICs are pivotal in various arthritis forms, including reactive, rheumatoid, and Lyme arthritis and systemic lupus erythematosus. Research indicates that intestinal barrier restoration during the pre-phase of arthritis could inhibit arthritis development. In the absence of animal models supporting extra-intestinal IBD manifestations, this paper aims to comprehensively explore the relationship between CICs and arthritis onset via a multifaceted analysis to offer a fresh perspective for further investigation and provide novel insights into the interplay between CICs and arthritis development in IBD.

[Analysis on the clinical characteristics and related risk factors of patients with hemorrhagic transformation after cerebral infarction].

OBJECTIVE: To analyze and summarize the clinical characteristics and risk factors for patients with hemorrhagic transformation (HT) after cerebral infarction to provide guidance for its clinical treatment and prevention. METHODS: In this study, data from 49 hospitalized patients with HT in the First Department of Neurology, China-Japan Union Hospital of Jilin University from October 2009 to March 2012, were reviewed retrospectively and 106 cases with acute cerebral infarction only during the same period, were chosen randomly as controls. Gender and age of the patients were comparable. Relevant information was collected. SPSS 17.0 statistical package was applied for data processing. Qualitative data were processed with χ(2) test, and measurable data was processed with t-test. Each index was analyzed with uni-variate analysis while statistically significant risk factors were included in the logistic review model to conduct the multivariate regression analysis. RESULTS: (1) Clinical symptoms deteriorating after hemorrhage in 21 cases accounted for 42.9% of the HT group, among which the cases on degree of disturbance to consciousness had an aggravation in 8 cases and hemiplegia increase in another 7 cases. Headaches and dizziness were found in 5 cases. (2) Number of infarction within 15 days after the occurrence of HT accounted for 87.0%. (3) HT-related factors increased the risk of HT in cerebral infarction such as cortical infarction, large area of infarction, atrial fibrillation, cerebral embolism, diabetes and high level of low-density lipoprotein cholesterol (P < 0.05). The most important factors were atrial fibrillation and cerebral embolism. (4) PH-2 seemed more unlikely to link with clinical symptoms than other subtypes of HT. CONCLUSION: Cerebral infarction after occlusion of the main artery trunk was prone to HT, especially when it appeared within 15 days. Short-term prognosis seemed to be related to the subtypes of HT, with risk factors as cortical infarct, massive cerebral infarction, atrial fibrillation, cerebral embolism, diabetes, high low-density lipoprotein cholesterol etc. on HT.