Interstitial Cystitis And Systemic Autoimmune Diseases

Main Category: Urology / Nephrology
Article Date: 02 Mar 2008 - 0:00 PDT

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UroToday.com - Clinical associations have been found between BPS/IC and allergy, irritable bowel syndrome, fibromyalgia, inflammatory bowel disease, and generalized autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's Syndrome. Van de Merwe has studied 110 unselected BPS/IC patients and was able to make a diagnosis of SS in 7.2%. Another 19% met 3 of the criteria for SS and would be diagnosed as having Sjögren's-like syndrome. Thus 25% of the patients in his IC population have a definite or probable diagnosis of SS. Autoantibodies which occur in 70% of patients with SS were found in 12.7% of his BPS/IC patients. These occur in less than 1% of healthy controls.

In a very interesting review, the author carries his observations one step further. He notes that the strong association between BPS/IC and SS in combination with evidence of a pathogenic role of autoantibodies to the M3 receptor warrants further exploration of a possible role of antibodies to M3Rs in causing early symptoms and later local inflammation in BPS/IC. The M3R is widely accepted as the receptor on detrusor cells that mediates cholinergic contraction of the normal urinary bladder and other smooth muscle tissues. Anti-M3R antibodies from SS patients have been found to induce detrusor contractions in mice and could be responsible for the initiation of a chronic immune response at the site of the M3Rs near the nerve endings after affinity maturation, thereby creating an environment in which proinflammatory cytokines induce detrusor cells to attract mast cells. This article provides a nice review of the relationship of BPS/IC to systemic autoimmune diseases, and in the new paradigm which places IC in the perspective of associated syndromes, provides a valuable path through which to use these associations to construct new and hopefully testable hypotheses.

Nature Clinical Practice Urology, 4:484-491, 2007
doi: 10.1038/ncpuro0874

Reported by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH Professor of Urology Division of Urology, Department of Surgery Hospital of the University of Pennsylvania Medical Director Department of Clinical Effectiveness and Quality Improvement University of Pennsylvania Health System Philadelphia, PA

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