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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.

BPS-associated diseases

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.

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

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

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.

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

Irritable bowel syndrome

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

Sjögren's syndrome

       full paper

 

       full paper

Summary

Systemic lupus erythematosus (including lupus cystitis)

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

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

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