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As comorbilidades autoimunes da doença inflamatória intestinal em idade pediátrica
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A Doença de Crohn (DC) e a Colite Ulcerosa (CU), conhecidas como doenças inflamatórias intestinais (DII), são doenças complexas e imunologicamente mediadas que afetam o trato gastrointestinal. Quase um quarto dos casos têm início durante a infância ou adolescência e vários estudos em populações pediátricas têm vindo a reportar o aumento da sua incidência, paralelamente ao aumento da incidência de outras doenças autoimunes, como colangite esclerosante primária, eritema nodoso, pioderma gangrenosum, psoríase, espondilite anquilosante, entre outras. Cerca de 17% das crianças com DII apresentam manifestações extraintestinais concomitantes, sendo mais frequentes na DC (30-71%), comparativamente com a CU (21- 22%). Na maioria dos casos, o diagnóstico das comorbilidades autoimunes associadas surge posteriormente ao da doença inflamatória intestinal, embora também se possa constatar o inverso, dificultando assim a inferência de associação. Estas manifestações apresentam consequências significativas na qualidade de vida dos doentes e requerem uma abordagem multidisciplinar. Em pacientes com sintomatologia articular, a abordagem diagnóstica de espondilartropatias deverá incluir a avaliação clínica e laboratorial e um exame de imagem, devendo a intervenção terapêutica basear-se em scores clínicos padronizados. Em caso de manifestações do foro dermatológico ou oftalmológico, o diagnóstico e o follow-up deverão ser baseados na avaliação clínica individualizada, incluindo adicionalmente, no caso de suspeita de patologia oftalmológica, o recurso a lâmpadas de fenda e testes de acuidade visual. Tanto o diagnóstico como o follow-up de colangiopatia deverão ser realizados mediante avaliação clínica, testes bioquímicos e imagiologia da árvore biliar. Algumas das comorbilidades autoimunes não se relacionam com a atividade da DII e, dessa forma, nem sempre existe uma relação direta com o outcome da DII. Contudo, alguns autores reportam que os doentes com mais sintomas de DII (indicador da gravidade da doença) apresentam maior risco de desenvolver uma comorbilidade autoimune.
Crohn’s disease (CD) and ulcerative colitis (UC), commonly known as inflammatory bowel diseases (IBD), are complex immune-mediated diseases that affect the gastrointestinal tract. Around one-quarter of the cases begin during childhood or adolescence, and several studies in pediatric populations have described an incidence increase, alongside an incidence increase in other autoimmune diseases such as primary sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum, psoriasis, ankylosing spondylitis, among others. About 17% of children with IBD have concomitant extraintestinal manifestations, which are more frequent in CD (30-70%) compared to UC (21-22%). In most cases, the diagnosis of autoimmune comorbidities follows the IBD diagnosis. However, the reverse can also be observed, hampering the association between them. These manifestations have significant consequences on the patients’ quality of life, requiring a multidisciplinary approach. Patients who present articular symptomatology demand the diagnosis approach of spondyloarthropathies. The diagnosis should include a clinical and laboratory evaluation, as well as an imaging exam, always basing the therapeutic intervention upon clinical standardized scores. In case of dermatological and ophthalmological manifestations, the diagnosis and the respective follow-up should be focused on an individualized clinical evaluation. Additionally, if there is a suspicion of ophthalmological pathology, the diagnosis should resort to slit lamps and visual acuity tests. Both the diagnosis and the follow-up of cholangiopathy should be performed through a clinical evaluation, biochemical tests, and imaging examination of the bile duct. Some of the autoimmune comorbidities are not related to the activity of IBD and, therefore, there is not always a direct relationship with the outcome of IBD. However, it has been reported that the risk of developing an autoimmune disease increases with increasing number of IBD-related symptoms (an indication of disease severity).
Crohn’s disease (CD) and ulcerative colitis (UC), commonly known as inflammatory bowel diseases (IBD), are complex immune-mediated diseases that affect the gastrointestinal tract. Around one-quarter of the cases begin during childhood or adolescence, and several studies in pediatric populations have described an incidence increase, alongside an incidence increase in other autoimmune diseases such as primary sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum, psoriasis, ankylosing spondylitis, among others. About 17% of children with IBD have concomitant extraintestinal manifestations, which are more frequent in CD (30-70%) compared to UC (21-22%). In most cases, the diagnosis of autoimmune comorbidities follows the IBD diagnosis. However, the reverse can also be observed, hampering the association between them. These manifestations have significant consequences on the patients’ quality of life, requiring a multidisciplinary approach. Patients who present articular symptomatology demand the diagnosis approach of spondyloarthropathies. The diagnosis should include a clinical and laboratory evaluation, as well as an imaging exam, always basing the therapeutic intervention upon clinical standardized scores. In case of dermatological and ophthalmological manifestations, the diagnosis and the respective follow-up should be focused on an individualized clinical evaluation. Additionally, if there is a suspicion of ophthalmological pathology, the diagnosis should resort to slit lamps and visual acuity tests. Both the diagnosis and the follow-up of cholangiopathy should be performed through a clinical evaluation, biochemical tests, and imaging examination of the bile duct. Some of the autoimmune comorbidities are not related to the activity of IBD and, therefore, there is not always a direct relationship with the outcome of IBD. However, it has been reported that the risk of developing an autoimmune disease increases with increasing number of IBD-related symptoms (an indication of disease severity).
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Doença inflamatória intestinal Comorbilidades autoimunes Manifestações extraintestinais Idade pediátrica Pediatria