The interested reader is referred to three recent reviews for more information on FIC. One article provides a concise general overview,1 another analyzes an evidence-based medicine approach to treatment and an overview of risk factors,2 and the thirdarticle provides yet another perspective.3Is this terminology more helpful than FUS or FLUTD or IC (FIC)? Results of studies over the past 20 years indicate that idiopathic/interstitial cystitis in cats is the result of complex interactions between the bladder, nervous system, adrenal glands, husbandry practices, and the environment in which the cat lives. Many cats with a diagnosis of chronic FIC have lower urinary tract-predominant clinical signs that are part of a larger systemic disorder referred to as "Pandora Syndrome."3'4 Clinical problems outside the lower urinary tract are common in those with a diagnosis of FIC and include signs related to the GI tract, respiratory system, skin, central nervous system, cardiovascular system, and the immune system. It has been traditional to refer tocats that have obvious LUT signs as those having "feline urological syndrome," "feline lower urinary tract disease," or "feline interstitial cystitis" but this method of naming the disease focuses on the organ with the predominant clinical sign rather than a thorough evaluation of the entire cat and all of its organ systems. A diagnosis of Pandora Syndrome would apply to those cats that exhibit clinical signs in other organ systems (in addition to the LUT), waxing and waning of clinical signs associatedwith stressful events that presumably activate the stress response system, and undergo resolution of severity of clinical signs following effective environmental enrichment. Currently available evidence suggests that many cases of chronic idiopathic LUTsigns presently diagnosed as having FIC actually do have a "Pandora" syndrome. The syndrome might result from early adverse experiences that sensitize the neuraxis to sensory input, increasing the frequency and duration of activation of the stress response system (SRS) when the individual is housed/living in a provocative environment. The chronic wear and tear of persistent activation of the SRS can upregulate the inflammatory response in a variety of tissues including the bladder.
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