Fistulating Crohn's disease in a patient with rheumatoid arthritis

摘要

With recent advances in the treatment of autoimmune conditions this can make the diagnosis in many patients with multiple autoimmune pathologies more difficult. Patients with inflammatory bowel disease have a high incidence of peripheral arthropathy, 0.4-34.6%. However, due to the crossover of treatments between rheumatoid arthritis and Crohn's it can be difficult to detect the latter condition.A 24-year-old male with a diagnosis of juvenile rheumatoid arthritis was admitted with colicky lower abdominal pain. He had no change in bowel habit, however examination revealed a tender mass in the right lower quadrant. Medications included methotrexate and diclofenac.Despite a baseline CRP of 40 his rheumatoid arthritis was well controlled with only one episode of joint inflammation in two years and some morning stiffness.The patient was taken to theatre for exploration and on opening the abdomen a mesenteric abscess and adhesions were found and excised. The appendix was secondarily inflamed and stuck to the abscess.