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Arthritis, Collagenous Colitis, and Discoid Lupus
- Jerome Castanet, MD;
- Jean-Philippe Lacour, MD; and
- Jean-Paul Ortonne, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Collagenous colitis usually begins as a chronic watery diarrhea. Its diagnosis is based on examination of colon biopsy specimens that show prominent subepithelial collagen deposition. Although more than 100 cases have been reported since 1980, association with immunologically mediated diseases is rare. We describe a patient with collagenous colitis, inflammatory polyarthritis, and discoid lupus.
A 45-year-old woman was hospitalized in 1992 for erythematous plaques on her face. During the preceding 8 years, her medical history included a symmetrical inflammatory polyarthritis of the metacarpals, elbows, shoulders, and knees that was thought to be seronegative rheumatoid arthritis. However, no clinical or radiologic evidence indicated a destructive arthropathy, and nonsteroidal anti-inflammatory agents relieved her pain. Simultaneously, a scarring alopecia of the scalp had started and was considered to be idiopathic pseudo-pelade. Occurrence of a chronic watery diarrhea in 1990 had led to the diagnosis of collagenous colitis, proved by examination of two colonic biopsy specimens. According to the patient, salazopyrin treatment had yielded a 50% improvement. She reported recent worsening of pseudo-pelade and occurrence of erythematous lesions on her face. Physical examination showed scarring alopecia and erythematous and keratotic plaques over the sun-exposed areas, especially the nose, consistent with a diagnosis of discoid lupus. Examination of cutaneous biopsy specimens of her scalp and nose confirmed the diagnosis. The patient was started on antimalarial treatment, resulting in a rapid and dramatic improvement of her joint pains and diarrhea.
Similar cases of inflammatory seronegative polyarthritis have been reported in association with collagenous colitis [1-3], exhibiting features usually not encountered in typical rheumatoid arthritis. In particular, the course of the arthritis associated with collagenous colitis is less severe and not destructive. We were unable to find in the literature other cases of an association between lupus and collagenous colitis. Despite rare reports of an association of collagenous colitis with other immunologically mediated diseases, especially systemic scleroderma [4], no proof exists for a proposed autoimmune cause for collagenous colitis. Although this association may have occurred by chance, physicians should be aware that it may occur.
Jerome Castanet, MD
Jean-Philippe Lacour, MD
Jean-Paul Ortonne, MD
Hopital Pasteur; 06002 Nice Cedex 1; France
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
