Confusable versus associated diseases
The words "confusable disease" and "associated disease" are always used in connection with another disease, in our situation in connection with BPS.
For BPS, a confusable disease is a disease which may show similar symptoms and/or signs to those of BPS. In general, such a confusable disease needs to be excluded as the main cause of the symptoms and/or signs before a diagnosis of BPS can be made. In practice, the situation may be more complex as the presence of a confusable disease does not necessarily exclude the presence of BPS as well. If both a confusable disease and BPS are present, it is clear that for individual diagnoses of patients and for epidemiological studies, the presence of a confusable disease should not exclude a diagnosis of BPS. For many scientific studies, on the other hand, e.g. for studies on the effect of a particular treatment, only patients with BPS without an additional confusable disease should be accepted as the confusable disease may severely interfere with outcome parameters of such a study.
BPS has several associated diseases. Associated diseases are diseases with a higher prevalence among patients with BPS than in the general population. This does not necessarily imply a causal relationship between BPS and the associated disease. The practical consequence of associated diseases is that medical professionals should know these associations and should have a high index of suspicion for the associated diseases.
General aspects of confusable diseases
Confusable diseases misdiagnosed as interstitial cystitis
A 73-year-old woman with chronic pelvic pain, burning toes, and an eighty-pound weight loss.
Birnbaum J, Chai TC, Ali TZ, Polydefkis M, Stone JH. Arthritis Rheum 2008;59:1825-31.
• an elderly woman is described with a 5-year history of chronic bladder and pelvic pain, an 80-pound weight loss, a small fiber neuropathy, and interstitial lung disease
• laboratory tests showed a strongly positive rheumatoid factor, and positive ANCA assays associated with perinuclear immunofluorescence and antigen specificity for myeloperoxidase.
• bladder biopsies containing bladder mucosa showed no specific abnormalities
• a (false) diagnosis of IC/PBS was made; only after a cystectomy was performed, a necrotizing vasculitis of medium-sized arteries was seen that led to the right diagnosis of microscopic polyangiitis (MPA); disease remission was obtained after adequate treatment for MPA
• it is likely that if deeper bladder biopsies would have been done containing detrusor muscle at initial evaluation, the correct diagnosis could have been made 5 years earlier; moreover, the patient would also have received adequate treatment for a potentially fatal disease 5 years earlier and a cystectomy wouldn't have been necessary
Dysuria and a headache.
Lo S, Noble J, Bowler I, Angus B. Lancet 2004;364:1554
• a case report of a 49-year-old white woman with symptoms of recurrent urinary tract infections; she had no other medical history of note and she had not traveled outside of the UK
• an initial diagnosis of interstitial cystitis was found to be wrong; despite she had no pulmonary disease, the cystitis was found to be due to infection withMycobacterium tuberculosis
Primary splenic marginal zone lymphoma with bladder metastases mimicking interstitial cystitis.
Tsiriopoulos I, Lee G, O' Reilly A, et al. Int Urol Nephrol 2006;38:475-6
A referral center’s experience with transitional cell carcinoma misdiagnosed as interstitial cystitis.
Tissot WD, Diokno AC, Peters KM. J Urol 2004;172:478-80
• a retrospective review of patient records showed that between 1998 and 2002 a total of 600 patients were seen with the diagnosis of interstitial cystitis (IC)
• six patients (1%) previously diagnosed as having IC were found to have transitional cell carcinoma as the cause of symptoms, 4 of whom (67%) had no hematuria
• the authors conclude that patients with irritative voiding symptoms require a thorough evaluation which may include cystoscopy, cytology and upper tract imaging; they expect that the number of wrong diagnoses of IC would increase if the criteria to diagnose IC and initiate treatment were oversimplified
Eosinophilic cystitis induced by penicillin.
Tsakiri A, Balslev I, Klarskov P. Int Urol Nephrol 2004;36:159-61
• a 30-year-old woman developed classic symptoms of painful bladder disease and eosinophilic cystitis as an adverse effect of penicillin for abdominal actinomycosis; the symptoms were reversible after stopping penicillin
Tiaprofenic acid: an uncommon cause of cystitis often misdiagnosed as interstitial cystitis.
Heritz DM, Thiessen JJ. Can J Urol 1996;3:202-5
• the authors describe 8 cases of cystitis due to the use of the non-steroidal anti-inflammatory drug tiaprofenic acid but with an initial wrong diagnosis of interstitial cystitis
• discontinuation of the drug will relieve symptoms usually within six weeks.
Reinvestigation of patients with a diagnosis of interstitial cystitis: common things are sometimes common.
Irwin P, Samsudin A. J Urol 2005;174:584-7
• 61 patients with a provisional diagnosis of IC underwent reinvestigation. The diagnosis of IC was confirmed or considered possible in only 34 cases. Common alternative diagnoses included recurrent urinary tract infections, detrusor overactivity and vaginal candidiasis. Of 5 male patients only 1 was confirmed to have IC !
General information on systemic lupus erythematosus
Systemic lupus erythematosus.
Rahman A, Isenberg DA. N Engl J Med 2008;358:929-39
• a great review on genetic and epidemiologic factors, autoantibodies, tissue damage by autoantibodies, the role of T cells, source of the autoantigens, cytokines and implications for treatment
Relationship between BPS and SLE
Interstitial cystitis and systemic lupus erythematosus in a 20-year old woman.
do Socorro Teixeira Moreira Almeida M, Carvalho LL, Carvalho AG, et al. J Rheumatol Int 2008 Aug 12. (Epub ahead of print] PMID: 18696074
• a case report of a 20-year-old woman with systemic lupus erythematosus; she presented with dysuria, urinary frequency and suprapubic pain and was found to have a interstitial cystitis
Interstitial cystitis and systemic autoimmune diseases.
van de Merwe JP. Nat Clin Pract Urol 2007;4:484-91
• a review
A case report of childhood systemic lupus erythematosus complicated with lupus cystitis.
Kurosawa R, Miyamae T, Imagawa T, et al. Nihon Rinsho Meneki Gakkai Kaishi 2006;29:154-9
• case report from Yokohama concerning a 13 year old girl with SLE complicated with lupus cystitis and successfully treated with IVCY-pulse therapy and maintenance prednisolone and azathioprin
A case of lupus cystitis with a history of idiopathic thrombocytopenic purpura.
Haranaka M, Kumagi M, Hino I, et al. Mod Rheumatol 2004;14:61-5
Voiding dysfunction in women with systemic lupus erythematosus.
Yu HJ, Lee WC, Lee KL, et al. Arthritis Rheum 2004;50:166-72
Is there an ethnic difference in the prevalence of lupus cystitis? A report of six cases.
Chen MY, Lee KL, Hsu PN, et al. Lupus 2004;13:263-9
• the authors have found a high prevalence of antibodies to SS-A in lupus cystitis patients
• webmaster's comment: many SLE patients with anti-SS-A have also "secondary" Sjögren's syndrome
Intercurrent autoimmune conditions in classic and non-ulcer interstitial cystitis.
Peeker R, Atanasiu L, Logadottir Y. Scand J Urol Nephrol 2003;37:60-3
Lupus cystitis on Ga-67 scans.
Lin WY, Lan JL, Wang SJ. Clin Nucl Med 2000;25:737
• a 46-year-old woman with systemic lupus erythematosus had hematuria, fever, and proteinuria. She was transferred to the nuclear medicine department for evaluation of the disease activity of lupus nephritis. A Ga-67 scan showed increased radioactivity in both kidneys. Active nephritis was suggested. Furthermore, increased Ga-67 uptake in the wall of the urinary bladder was also noted. Lupus cystitis was indicated. A bladder biopsy confirmed the diagnosis.
Lower urinary tract symptoms in patients with Sjogren's syndrome and systemic lupus erythematosus.
Haarala M, Alanen A, Hietarinta M, Kiilholma P. Int Urogynecol J Pelvic Floor Dysfunct 2000;11:84-6
Interstitial cystitis: unexplained associations with other chronic disease and pain syndromes.
Alagiri M, Chottiner S, Ratner V, et al. Urology 1997;49(5A Suppl):52-7
Systemic lupus erythematosus relapse with lupus cystitis
Nakauchi Y, Suehiro T, Tahara K, et al. Clin Exp Rheumatol 1995;13:645-8
• a case report
Bowel perforation and interstitial cystitis in childhood systemic lupus erythematosus.
Eberhard A, Shore A, Silverman E, Laxer R. J Rheumatol 1991;18:746-7
Involvement of the urinary bladder in systemic lupus erythematosus. A pathologic study.
Alarcon-Segovia D, Abud-Mendoza C, Reyes-Gutierrez E, et al. J Rheumatol 1984;11:208-10
• urinary bladder histologic changes were found in 16 of 35 necropsies from systemic lupus erythematosus (SLE) patients; these included interstitial cystitis (n = 11), hemorrhage (n = 9), congestion (n = 7), vasculitis (n = 5), and perivenular infiltrate (n = 4)
Chronic interstitial cystitis as an initial major manifestation of systemic lupus erythematosus.
de la Serna AR, Alarcon-Segovia D. J Rheumatol 1981;8:808-10
Similarity of interstitial cystitis to lupus erythematosus.
Fister GM. J Urol 1938;40:37-51
Urinary tract infections
Human Papilloma Virus
Cystitis: other causes
Other bladder conditions
Bladder neck obstruction
Bladder stone and lower ureteric stone
Incomplete bladder emptying (retention)