Associations rares ou trompeuses entre pathologies articulaires et pathologies hépato-gastro-entérologiques

In children, the combination of diarrhoea and arthritis can disclose rare disorders: tufting enteropathies, with excessive gut permeability; camptodactyly-arthropathy-coxa vara-pericarditis, sometimes associated with digestive features secondary to intestinal lymphangiectasia induced by the chronic constrictive pericarditis; IPEX syndromes (immune dysregulation, polyendocrinopathy, enteropathy, X-linked) due to FOXP3 genetic defects, sometimes include a combinaison of arthritis and digestive troubles; the same holds true for APECED syndromes (mutations of AIRE). In adults, esophagus achalasia is associated with uveitis, and less frequently with psoriatic arthritis or Sjögren's syndromes. Ascitis can herald rheumatoid arthritis, and exsudative enteropathies worsen some Sjögren's syndromes. Mesenteric panniculitis have been observed in Sjögren's syndromes, rheumatoid arthritis and ankylosing spondylitis. The PPP syndrome (panniculitis-pancreatitis-polyarthritis) is consecutive to the systemic release of pancreatic enzymes. Its prognosis is poor if (false)-cysts from which enzymes are periodically discharged cannot be quickly surgically removed. In patients with undifferentiated polyarthritis, chronic cholostasis must lead to the search of anti-mitochondrial antibodies and anti-nuclear dots (indicative of primitive cholangitis). If such auto-antibodies are not found, a liver biopsy can reveal sclerosing cholangitis. Some arthritis can antedate auto-immune hepatitis (type 1, with anti-actin and/or anti-SLA antibodies, or type 2, with anti-LKM1 antibodies) which require a quick treatment by high doses of corticosteroids. Nodular regenerative liver hyperplasia can complicate lupus, polyarthritis, and Felty's syndromes.