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Confusable versus associated diseases

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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.

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BPS-associated diseases

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General

  • The Fibromyalgia Bladder Index. 
    Brand K, Littlejohn G, Kristjanson L, et al. Clin Rheumatol. 2007 May 3; [Epub ahead of print] 
    • the aim of this study was to determine whether the Interstitial Cystitis Symptom and Problem Index (ICSI/ICPI), is a valid, reliable, and clinically relevant instrument to assess the sensory urinary symptoms in women with fibromyalgia syndrome (FM) 
    • factor analysis displayed two separate components of symptom and problem combinations as distinct from the original ICSI/ICPI developed for the interstitial cystitis population 
    • the eight items of the index configured differently and formed two subscales of a newly developed Fibromyalgia Bladder Index 
    • the two subscales of this index include the Bladder Urgency and Pain Subscale and the Bladder Frequency and Nocturia Subscale.

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Allergy

  • Effect of Comestibles on Symptoms of Interstitial Cystitis. 
    Shorter B, Lesser M, Moldwin RM, Kushner L. J Urol 2007 May 10; [Epub ahead of print] 
    • patients with painful bladder syndrome/interstitial cystitis 90.2% indicated that the consumption of certain foods or beverages caused symptom exacerbation
    • there was no correlation between allergies and the effect of comestibles on symptoms 
    • the most frequently reported and most bothersome comestibles were coffee, tea, soda, alcoholic beverages, citrus fruits and juices, artificial sweeteners and hot pepper

 

Relationship between allergy and irritable bowel syndrome

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Crohn's disease

  • Intercurrent autoimmune conditions in classic and non-ulcer interstitial cystitis. 
    Peeker R, Atanasiu L, Logadottir Y. Scand J Urol Nephrol 2003;37:60-3 
    • inflammatory bowel disease was not diagnosed in any of the patients with non-ulcer IC (n=93) whereas 2.3% of the patients with classic IC (n=129) had either ulcerative colitis or Crohn's disease, approximately 33 times the prevalence seen in the general population

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Fibromyalgia

  • A systematic review on the effectiveness of treatment with antidepressants in fibromyalgia syndrome. 
    Uçeyler N, Häuser W, Sommer C. Arthritis Rheum 2008;59:1279-98
    • in this systematic review it is concluded that amitriptyline (25-50 mg/day) reduced pain, fatigue, and depressiveness in patients with fibromyalgia and improved sleep and quality of life 
    • most SSRIs and the SNRIs duloxetine and milnacipran are probably also effective
    • the authors recommend short-term treatment of patients with fibromyalgia using amitriptyline or another of the antidepressants that were effective in randomized-controlled trials but warn that data on long-term efficacy are lacking

  • The Fibromyalgia Bladder Index. 
    Brand K, Littlejohn G, Kristjanson L, et al. Clin Rheumatol 2007;26:2097-103 
    • the aim of this study was to determine whether the Interstitial Cystitis Symptom and Problem Index (ICSI/ICPI), is a valid, reliable, and clinically relevant instrument to assess the sensory urinary symptoms in women with fibromyalgia syndrome (FM) 
    • factor analysis displayed two separate components of symptom and problem combinations as distinct from the original ICSI/ICPI developed for the interstitial cystitis population 
    • the eight items of the index configured differently and formed two subscales of a newly developed Fibromyalgia Bladder Index 
    • the two subscales of this index include the Bladder Urgency and Pain Subscale and the Bladder Frequency and Nocturia Subscale.

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Inflammatory bowel disease

  • Intercurrent autoimmune conditions in classic and non-ulcer interstitial cystitis. 
    Peeker R, Atanasiu L, Logadottir Y. Scand J Urol Nephrol 2003;37:60-3 
    • inflammatory bowel disease was not diagnosed in any of the patients with non-ulcer IC (n=93) whereas 2.3% of the patients with classic IC (n=129) had either ulcerative colitis or Crohn's disease, approximately 33 times the prevalence seen in the general population

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Irritable bowel syndrome

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Rheumatoid arthritis

  • Lower urinary tract symptoms in female patients with rheumatoid arthritis. 
    Lee KL, Chen MY, Yeh JH, et al. Scand J Rheumatol 2006;35:96-101
    • patients with RA were found to have similar urinary complaints when compared to controls; however, those with secondary SS had a greater severity of lower urinary tract symptoms, a finding similar to that observed in patients with primary SS

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Sjögren's syndrome

       full paper

 

       full paper

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Summary

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Systemic lupus erythematosus (including lupus cystitis)

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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

  • 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.

  • 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)

  • Similarity of interstitial cystitis to lupus erythematosus. 
    Fister GM. J Urol 1938;40:37-51

 

Ulcerative colitis

  • Intercurrent autoimmune conditions in classic and non-ulcer interstitial cystitis. 
    Peeker R, Atanasiu L, Logadottir Y. Scand J Urol Nephrol 2003;37:60-3 
    • inflammatory bowel disease was not diagnosed in any of the patients with non-ulcer IC (n=93) whereas 2.3% of the patients with classic IC (n=129) had either ulcerative colitis or Crohn's disease, approximately 33 times the prevalence seen in the general population

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Vulvodynia

  • Vulvodynia. Definition, diagnosis and treatment. 
    Petersen CD, Lundvall L, Kristensen E, et al. Acta Obstet Gynecol Scand 2008;87:893-901 
    • this article describes the terminology and definition of the condition, theories on patho-physiological mechanisms underlying the disorder, methods of diagnosis and evidence and recommendations on clinical management

  • Treatment of vulvodynia with tricyclic antidepressants: efficacy and associated factors. 
    Reed BD, Caron AM, Gorenflo DW, Haefner HK. J Low Genit Tract Dis 2006;10:245-51 
    • women with vulvodynia who were prescribed a tricyclic antidepressant in general (or amitriptyline, specifically) were more likely to have pain improvement compared with those women not taking these medications at follow-up
    • randomized, controlled studies of tricyclic antidepressants versus other treatments are needed to clarify the overall effectiveness of these drugs

ASSOCIATED DISEASES

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