ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 4 of 44
УЖМБС 2022, 7(3): 27–36
Medicine. Reviews

Pecularities of the Pancreatitis Development on the Background of Some Rheumatic Diseases

Teleki Ya. M., Khrystych T. M., Olinik O. Yu., Ibragimov E. Yu., Gorodinsky S. I.

The purpose of the study was to evaluate the main pathogenetic mechanisms of pancreatic lesions on the background of systemic connective tissue diseases based on the analytical analysis of modern literature data. Materials and methods. Bibliosemantic and analytical methods were used in the research. Results and discussion. The main pathogenetic link of the pancreatitis development in patients with systemic connective tissue diseases is vasculitis of the pancreas. Increased expression of adhesion molecules with activation of leukocytes and endothelial cells, deposition of circulating immune complexes in the vascular wall, production of antibodies to endothelial cells, capillary basement membranes play an important role in this process. In systemic lupus erythematosus, according to various authors, the frequency of arteritis varies greatly: rates range from 6.2-7.4 to 53%. In rheumatoid arthritis, the frequency of arteritis of the pancreatic vessels reaches 50%, in systemic sclerosis – 17%. Secondary Sjogren's syndrome is associated with autoimmune pancreatitis in a quarter of cases, but is not the cause. In diseases such as rheumatoid arthritis, systemic scleroderma and systemic lupus erythematosus, antibodies that can attack phospholipids of cell membranes are produced. Antiphospholipid syndrome develops often in systemic lupus erythematosus (70% of cases). In rheumatic fever patients’ changes in the pancreas were studied only in single studies. The main mechanism of pathogenesis of both acute and chronic pancreatitis in nodular periarteritis is the involvement of small and medium arteries of the pancreas in the pathological process. In granulomatous polyangiitis in the pancreas reveals vascular-granulomatous changes, resulting in the formation of extravasations, necrotic foci, foci of atrophy, sclerosis. In IgA vasculitis, changes in the structure of the pancreas are minimal or there are isolated small subcapsular hemorrhages. It is established that metabolic disorders occur in many rheumatic diseases. Thus, reduced glucose tolerance is observed in 7–74% of patients, hypercholesterolemia and triglyceridemia – in 50–75%, hypertension – in 25–50% of cases. Conclusion. Thus, the diagnostic approach to the pancreatitis in systemic connective tissue diseases is very difficult. Its manifestations are masked by damage of the other organs. The availability of more sensitive diagnostic methods, their accessibility can provide an opportunity to detect symptoms of pancreatitis earlier, which will contribute to the appointment of optimal treatment, improvement of the prognosis, quality of life and survival of such patients

Keywords: systemic connective tissue diseases, pathogenesis, pancreatitis, pancreas

Full text: PDF (Ukr) 291K

  1. Golovach YYu, Egudyna ED. Vaskulytnaya neyropatyya: problemy klynyko-dyagnostycheskoy veryfykatsyy pry systemnykh y nesystemnykh vaskulytakh [Vasculitic neuropathy: the problem of clinical and diagnostic verifications in systemic and non-systemic vasculitis]. Ukr Revmatolog Zh. 2019;1:20-9. [Russian]
  2. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Reum. 2013;65(1):1-11. PMID: 23045170.
  3. Naddaf E, Dyck PJ. Vasculitic neuropathies. Curr Treat Options Neurol. 2015;17(10):374. PMID: 26346349.
  4. Tian XP, Zhang X. Gastrointestinal involvement in systemic lupus erythematosus: insight into pathogenesis, diagnosis and treatment. World J Gastroenterol. 2010;16(24):2971-7. PMID: 20572299. PMCID: PMC2890936.
  5. Odaira C, Koizumi M, Fujiwara A. A study of pancreatitic injurу in patients with SLE (in Japanese). Nippon Shokakibyo Gakkai Zasschi. 1987;84:2722-30.
  6. Suda K, Ed. Pancreas - Pathological Practice and Research. Basel; 2007. 318 p.
  7. Melamed N, Molad Y. Spontaneous retroperitoneal bleeding from renal microaneurysms and pancreatic pseudocyst in a patient with systemic lupus erythematosus. Scand J Rheumatol. 2006;35(6):481-4. PMID: 17343259.
  8. Kauppi M, Kankaanpää E, Kautiainen H. Exocrine dysfunction of the pancreas in patients with chronic polyarthritis. J Clin Rheumatol. 2001;7(3):166-9. PMID: 17039122.
  9. D'Ambrosi A, Verzola А, Buldrini P, Vavalle С, Panareo S, Gatto S, et al. Pancreatic duct antibodies and subclinical insufficiency of the exocrine pancreas in Sjоgren's syndrome. Recenti Prog Med.1998;89(10):504-9.
  10. Nishimori I, Tamakoshi A, Otsuki M. Prevalence of autoimmune pancreatitis in Japan from a nationwide survey in 2002. J Gastroenterol. 2007;42(Suppl 18):6-8. PMID: 17520216.
  11. Pickartz T, Pickartz H, Lochs H, Ockenga J. Overlap syndrome of autoimmune pancreatitis and cholangitis associated with secondary Sjоgren's syndrome. Eur J Gastroenterol Hepatol. 2004;16(12):1295-9. PMID: 15618835.
  12. Khrystych TM, Temerivska TG, Gontsaryuk DO. Khronichnyy pankreatyt: suchasnyy poglyad na etiologiyu, patogenez, kliniku, likuvannya ta medychnu reabilitatsiyu khvorykh na khronichnyy pankreatyt [Chronic pancreatitis: a modern view of the etiology, pathogenesis, clinic, treatment and medical rehabilitation of patients with chronic pancreatitis]. Navch-metod posib. Chernivtsi; 2018. 172 s. [Ukrainian]
  13. Matsuda M, Hamano H, Yoshida T, Gono T, Uehara T, Kawa S, et al. Seronegative Sjоgren syndrome with asymptomatic autoimmune sclerosing pancreatitis. Clin Rheumatol. 2007;26(1):117-9. PMID: 16362447.
  14. Fukui O, Okazaki K, Yoshizawa H, Ohashi S, Tamaki H, Kawasaki K, et al. A Case of Autoimmune Pancreatitis Associated with Sclerosing Cholangitis, Retroperitoneal Fibrosis and Sjögren's Syndrome. Pancreatology. 2005;5(1):86-91. PMID: 15775703.
  15. Akahane C, Takei Y, Horiuchi A, Kawa S, Nishimori I, Ikeda S. A primary Sjоgren's syndrome patient with marked swelling of multiple exocrine glands and sclerosing pancreatitis. Intern Med. 2002;41(9):749-53. PMID: 12322807.
  16. Sène D, Jallouli M, Lefaucheur JP, Saadoun D, Costedoat-Chalumeau N, Maisonobe T, et al. Peripheral neuropathies associa ted with primary Sjogren syndrome: immunologic profiles of nonataxic sensory neuropathy and sensorimtor neuropathy. Medicine (Baltimore). 2011;90(2):133-8. PMID: 21358442.
  17. Lang D, Zwerina J, Pieringer H. IgG4-related disease: current challenges and future prospects. Ther Clin Risk Manag. 2016;12:189-99. PMID: 26929632. PMCID: PMC4760655.
  18. Sebastian A, Sebastian M, Misterska-Skóra M, Donizy P, Halon A, Chlebicki A, et al. The variety of clinical presentations in IgG4-related disease in Rheumatology. Rheumatol Int. 2018;38(2):303-9. PMID: 28856463. PMCID: PMC5773660.
  19. Yaremenko OB, Kolyadenko DI, Petelytska LB. IgG4-zalezhne zakhvoryuvannya: stan problemy y opys klinichnogo vypadku [IgG-dependent disease: the state of the problem in the description of the clinical case]. Ukr Revmatol Zh. 2019;1:10-9. [Ukrainian]
  20. Vyas A, Kadikoy H, Haque W, Abdellatif A. Catastrophic antiphospholipid syndrome presenting as ischemic pancreatitis in systemic lupus erythematosus. JOP. 2009;4(5):566-9.
  21. Cornelis T, Breynaert C, Blockmans D. An abdominal pain syndrome in a lupus patient. Clin Rheumatol. 2008;27(2):257-9. PMID: 17676382.
  22. Ozenc A, Altun H, Hamaloglu E, Ozdemir A. A case of acute pancreatitis in a patient with systemic lupus erythematosus. Acta Chir Belg. 2005;105(3):319-21. PMID: 16018530.
  23. Campos LM, Omori CH, Lotito AP, Jesus AA, Porta G, Silva CA. Acute pancreatitis in juvenile systemic lupus erythematosus: a manifestation of macrophage activation syndrome? Lupus. 2010;19(14):1654-58. PMID: 20837568.
  24. Kumagai K, Tamano M, Kojima K, Maeda C, Tominaga K, Hashimoto T, et al. A case of acute pancreatitis with systemic lupus erythematosus. Nippon Shokakibyo Gakkai Zasshi. 2010;107(2):278-84.
  25. Xu D, Yang H, Lai CC, Li P, Zhang X, Yang XO, et al. Clinical analysis of systemic lupus erythematosus with gastrointestinal manifestations. Lupus. 2010;19(7):866-9. PMID: 20410154.
  26. Geraldino GC, Polizelli DV, Pedroso CL, de Toledo RA, Bertazzi GR, de Toledo RA, et al. Systemic lupus erythematosus presenting as autoimmune parotitis and pancreatitis - Case Report. Acta Reumatol Port. 2010;35(2):241-3.
  27. Makol A, Petri M. Pancreatitis in systemic lupus erythematosus: frequency and associated factors - a review of the Hopkins Lupus Cohort. J Rheumatol. 2010;37(2):341-5. PMID: 20032096.
  28. Nesher G, Breuer GS, Temprano K, Moore TL, Dahan D, Baer A, Alberton J, et al. Lupus-associated pancreatitis. Semin Arthritis Rheum. 2006;35(4):260-7. PMID: 16461071.
  29. Cairoli E, Pérez G, Briva A, Cancela M, Alonso J. Fatal acute pancreatitis complicated by pancreatic pseudocysts in a patient with systemic lupus erythematosus. Rheumatol Int. 2010;30(5):675-8. PMID: 19466420.
  30. Myung DS, Kim TJ, Lee SJ, Park SC, Kim JS, Kim JC, et al. Lupus-associated pancreatitis complicated by pancreatic pseudocyst and central nervous system vasculitis. Lupus. 2009;18(1):74-7. PMID: 19074172.
  31. Breuer GS, Baer A, Dahan D, Nesher G. Lupus-associated pancreatitis. Autoimmun Rev. 2006 May;5(5):314-8. Epub 2006 Jan 27. PMID: 16782555. Singh S. Drug induced pancreatitis might be a class effect of statin drugs. JOP. 2005;6(4):380-1. PMID: 16782555.
  32. Gubergryts NB, Belyaeva NV, Klochkov AE, Lukashevych GM, Fomenko PG. Gastroenterologyya: trudnye bolnye [Gastroenterology: difficult patients]. K: RedByz Laboratoryya Medytsynskogo Byznesa; 2019. 492 s. [Russian]
  33. Golovach IYu, Yegudina YeD. Urazhennya shlunkovo-kyshkovogo traktu pry systemniy sklerodermiyi: diagnostychno-likuvalni aspekty [Injury of the gastrointestinal tract in systemic scleroderma: diagnostic and therapeutic aspects]. Suchasna gastroenterologiya. 2019;2:99-113. [Ukrainian].
  35. Kamisawa T, Funata N, Hayashi Y, Tsuruta K, Okamoto A, Amemiya K, et al. Close relationship between autoimmune pancreatitis and multifocal fibrosclerosis. Gut. 2003;52(5):683-7. PMID: 12692053. PMCID: PMC1773660.
  36. Maev YV, Kucheryavyy YuA. Bolezny podzheludochnoy zhelezy [Diseases of the pancreas]. M: GEOTAR-Medya; 2009. 736 s. [Russian]
  37. Nesterov AY, Sydygyn AYa. Klynyka kollagenovykh bolezney [Clinic of collagen diseases]. M: Medytsyna; 1966. 483 s. [Russian]
  38. Kovalenko VM, Bortkevych OP. Komorbidnist: vyznachennya, mozhlyvi napryamky diagnostyky ta likuvannya. Ukr Revmatol Zh. 2019;3:33-44. [Ukrainian]
  39. Li L, Neogi T, Jick S. Giant cell arteritis ayl vascular giseases - risk factors and outcomes: a cohort stady using UK Clinical Practice Research Danalink. Rhеumatology (Oxford). 2017;56(5):753-62. PMID: 28077689.
  40. Ungprasert P, Upala S, Sanguankeo A, Warrington KJ. Patients with gaint cell arteritis have a lower prevalence of diabetesmellitus: a systematic review and meta-analysis. Mod Rheumatol. 2016;26(3):410-4. PMID: 26381748.