潰瘍性結腸炎合併多發性肌炎、多發性關節炎及肝炎：結腸切除後改善

Ulcerative Colitis Associated with Polymyositis, Polyarthritis, and Hepatitis: Response to Partial Colectomy

潰瘍性結腸炎為一多系統性疾病常合併很多腸外症候群為表現。這些表現可能發生在潰瘍性結腸炎之前、同時或之後才顯現。而肌肉骨骼系統的表現較為罕見，文獻上只有少數病例報告。我們報告一位56歲男性病患，主訴多發性關節炎約半年，接著病人遭受潰瘍性結腸炎，多發性肌炎及肝炎。病患雖然接受高劑量類固醇治療，但症狀並未改善，而且併發大腸穿孔，經緊急部分大腸切除後，上述病症才逐漸改善。這意味著肌肉骨骼系統表現常和大腸的活性有關。潰瘍性結腸炎合併關節炎之可能機轉為大腸上皮和關節軟骨之交叉反應。這些合併症較罕見，最後可能的原因是自體免疫機轉所引起的。

Ulcerative colitis is a multisystemic disease associated with many extraintestinal manifestations. These various disease states can be diagnosed before, concomitant with, or after the diagnosis of ulcerative colitis. Musculoskeletal involvement is rare, and only a few cases have been reported. We report a 56-year-old man, who had migratory polyarthritis for a half year, and who presented with fever, a flare-up of polyarthritis, proximal muscle weakness, and bloody stool. Ulcerative colitis, polymyositis, polyarthritis, and hepatitis were confirmed by clinical and histological evidence. The patient was refractory to high-dose corticosteroid therapy, and complicated with colon perforation. Joint pain and muscle power improved after partial colectomy, which indicated that the activity of the musculoskeletal disease paralleled that of the bowel disease. The cross-reactive peptide between the colon epithelium and the chondrocytes may provide the basis for the arthritis in ulcerative colitis. The combination of these disease entities is rare and an autoimmune link between them is likely.