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Abstract
In the article, the authors outlined some etiological and pathogenetic links in the onset of pancreatitis, morphological features, and variants of symptoms of the pancreas associated with rheumatic diseases. It is emphasized that, more often than not, acute or chronic pancreatitis occurs in connection with vasculitis. We presented the mechanisms of development in periarteritis nodosa, systemic lupus erythematosus, and rheumatoid arthritis. Necrotizing arteritis of pancreatic vessels occurs with a frequency of 60% in periarteritis nodosa, ranging from 6.2–7.4 to 53% in systemic lupus erythematosus, 50% in rheumatoid arthritis, and 17% in scleroderma. Changes in intrapancreatic arteries of small and medium caliber occur in 71% of cases.
We presented the mechanisms of development, symptoms, types, diagnostic search, and differential diagnosis of autoimmune pancreatitis. A feature of the course is the presence of both acute and chronic pancreatitis, indicating the possibility of pancreatic infarction due to thrombosis as part of the antiphospholipid syndrome.
We analyzed the unique characteristics of pancreatic injury in scleroderma, which include damage to the structure and function of multiple organs and digestive systems. Changes in the vascular bed, problems with cellular immunity caused by CD4+ T lymphocytes and Th2 helper cells, and excessive fibrosis are all to blame. They cause fibrosis by releasing profibrotic cytokines and also have a direct effect on fibroblasts. In this case, dysfunctions and disturbances in the motility of the digestive canal occur; sphincter Oddi dysfunction is of great importance. This leads to the formation of pain syndrome or exocrine pancreatic insufficiency.
The authors revealed in detail the features of morphological changes in the pancreas in periarteritis nodosa. The changes are associated with either destructive-productive or productive panvasculitis of the medium and small arteries. Lymphocytes, macrophages, and plasmacytes primarily determine focal infiltration in the gland’s stroma. We observed a clinical picture of classic pancreatitis. Symptoms of pancreatic attack appear with high activity of the underlying disease, while in the inactive phase, functional failure of the pancreas occurs. Attention is focused on the significance of vasculitis of large vessels in giant cell arteritis.
References
Головач І. Ю., Єгудіна Є. Д. Васкулітна нейропатія: проблеми клініко-діагностичної верифікації при системних та несистемних васкулітах. Український ревматологічний журнал. 2019. № 1. С. 20–29.
Головач І. Ю., Єгудіна Є. Д. Ураження шлунково-кишкового тракту при системній склеродермії: діагностично-лікувальні аспекти. Сучасна гастроентерологія. 2019. № 2. С. 99–113.
Губергріц Н. Б., Бєляєва Н. В., Клочков О. Є., Лукашевич Г. М., Фоменко П. Г. Гастроентерологія: важкі хворі. Київ: РедБіз Лабораторія Медичного Бізнесу, 2019. 492 с.
Коваленко В. М., Борткевич О. П. Коморбідність: визначення, можливі напрямки діагностики та лікування. Український ревматологічний журнал. 2019. № 3. С. 33–44.
Христич Т. М., Темерівська Т. Г., Гонцарюк Д. О. Хронічний панкреатит: сучасний погляд на етіологію, патогенез, клініку, лікування та медичну реабілітацію хворих на хронічний панкреатит: навч.-метод. посіб. Чернівці, 2018. 172 с.
Христич Т. М., Телекі Я. М., Гонцарюк Д. О., Оліник О. Ю., Жигульова Е. О. Хронічний панкреатит: клінічно-патогенетичні особливості розвитку поєднання деяких захворювань та методи медикаментозної корекції (2-ге вид., перероб. та доп. Чернівці, 2022. 584 с.
Яременко О. Б., Коляденко Д. І., Петелицька Л. Б. IgG4-залежне захворювання: стан проблеми й опис клінічного випадку. Український ревматологічний журнал. 2019. № 1. С. 10–19.
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. Vol. 41, No 9. P. 749–753.
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. Vol. 30, No 5. P. 675–678.
Campos L. M., Omori C. H., Lotito A. P., Jesus A. A., Porta G., Silva C. A. Acute pancreatitis in juvenile systemic lupus erythematosus: a manifestation of macrophage activation syndrome? Lupus. 2010. Vol. 19, No 14. P. 1654–1658.
Fukui O., Okazaki K., Yoshizawa H., Ohashi S., Tamaki H., Kawasaki K., Matsuura M., Asada M., Nakase H., Nakashima Y., Nishio A. A case of autoimmune pancreatitis associated with sclerosing cholangitis, retroperitoneal fibrosis and Sjögren’s syndrome. Pancreatology. 2005. Vol. 5, No 1. P. 86–91.
Jennette J. C. Overview of the 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Clin. Experim. Nephrol. 2013. Vol. 65, No 1. P. 1–11.
Kamisawa T., Funata N., Hayashi Y., Tsuruta K., Okamoto A., Amemiya K., Egawa N., Nakajima H. Close relationship between autoimmune pancreatitis and multifocal fibrosclerosis. Gut. 2003. Vol. 52, No 5. P. 683–687.
Kumagai K., Tamano M., Kojima K., Maeda C., Tominaga K., Hashimoto T., Akima T., Nakano M., Sugaya T., Shimoda M., Kubota K. A case of acute pancreatitis with systemic lupus erythematosus. Nippon Shokakibyo Gakkai Zasshi. 2010. Vol. 107, No 2. P. 278–284.
Lang D., Zwerina J., Pieringer H. IgG4-related disease: current challenges and future prospects. Ther. Clin. Risk Manag. 2016. Vol. 12. P. 189–199.
Li L., Neogi T., Jick S. Giant cell arteritis and vascular disease — risk factors and outcomes: a cohort study using UK Clinical Practice Research Datalink. Rheumatology. 2017. Vol. 56, No 5. P. 753–762.
Makol A., Petri M. Pancreatitis in systemic lupus erythematosus: frequency and associated factors — a review of the Hopkins Lupus Cohort. J. Rheumatol. 2010. Vol. 37, No 2. P. 341–345.
Matsuda M., Hamano H., Yoshida T., Gono T., Uehara T., Kawa S., Ikeda S. I. Seronegative Sjögren syndrome with asymptomatic autoimmune sclerosing pancreatitis. Clin. Rheumatol. 2007. Vol. 26, No 1. P. 117–119.
Melamed N, Molad Y. Spontaneous retroperitoneal bleeding from renal microaneurysms and pancreatic pseudocyst in a patient with systemic lupus erythematosus. Scand. J. Rheumatol. 2006. Vol. 35, No 6. P. 481–484.
Myung D. S., Kim T. J., Lee S. J., Park S. C., Kim J. S., Kim J. C., Yoon W., Lee S. S., Park Y. W. Lupus-associated pancreatitis complicated by pancreatic pseudocyst and central nervous system vasculitis. Lupus. 2009. Vol. 18, No 1. P. 74–77.
Nesher G., Breuer G. S., Temprano K., Moore T. L., Dahan D., Baer A., Alberton J., Izbicki G., Hersch M. Lupus-associated pancreatitis. Semin. Arthritis Rheum. 2006. Vol. 35, No 4. P. 260–267.
Nishimori I., Tamakoshi A., Otsuki M. Prevalence of autoimmune pancreatitis in Japan from a nationwide survey in 2002. J. Gastroenterol. 2007. Vol. 42, Suppl. 18. P. 6–8.
Odaira C., Koizumi M., Fujiwara A. A study of pancreatic injurу in patients with SLE (in Japanese). Nippon Shokakibyo Gakkai Zasschi. 1987. Vol. 84. P. 2722–2730.
Pickartz T., Pickartz H., Lochs H., Ockenga J. Overlap syndrome of autoimmune pancreatitis and cholangitis associated with secondary Sjögren’s syndrome. Eur. J. Gastroenterol. Hepatol. 2004. Vol. 16, No 12. P. 1295–1299.
Sebastian A., Sebastian M., Misterska-Skóra M., Donizy P., Halon A., Chlebicki A., Lipiński A., Wiland P. The variety of clinical presentations in IgG4-related disease in Rheumatology. Rheumatol. Int. 2018. Vol. 38, No 2. P. 303–309.
Sène D., Jallouli M., Lefaucheur J. P., Saadoun D., Costedoat-Chalumeau N., Maisonobe T., Diemert M. C., Musset L., Haroche J., Piette J. C., Amoura Z. Peripheral neuropathies associa ted with primary Sjögren syndrome: immunologic profiles of nonataxic sensory neuropathy and sensorimtor neuropathy. Medicine. 2011. Vol. 90, No 2. P. 133–138.
Singh S. Drug induced pancreatitis might be a class effect of statin drugs. JOP. 2005. Vol. 6, No 4. P. 380–381.
Suda K. (ed.). Pancreas — Pathological Practice and Research. Basel, 2007. 318 p.
Tian X. P., Zhang X. Gastrointestinal involvement in systemic lupus erythematosus: insight into pathogenesis, diagnosis and treatment. World J. Gastroenterol. 2010. Vol. 16, No 24. P. 2971–2977.
Ungprasert P., Upala S., Sanguankeo A., Warrington K. J. Patients with giant cell arteritis have a lower prevalence of diabetes mellitus: a systematic review and meta-analysis. Mod. Rheumatol. 2016. Vol. 26, No 3. P. 410–414.
Vyas A., Kadikoy H., Haque W., Abdellatif A. Catastrophic antiphospholipid syndrome presenting as ischemic pancreatitis in systemic lupus erythematosus. JOP. 2009. Vol. 4, No 5. P. 566–569.
Xu D., Yang H., Lai C. C., Li P., Zhang X., Yang X. O., Zhang F. C., Qian J. M. Clinical analysis of systemic lupus erythematosus with gastrointestinal manifestations. Lupus. 2010. Vol. 19, No 7. P. 866–869.