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Autoimmune disease bladder: Interstitial cystitis and systemic autoimmune diseases

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Interstitial cystitis and systemic autoimmune diseases

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Review

. 2007 Sep;4(9):484-91.

doi: 10.1038/ncpuro0874.

Joop P van de Merwe 
1

Affiliations

Affiliation

  • 1 Erasmus MC, University Medical Center Rotterdam, Departments of Immunology and Internal Medicine, Dr Molewaterplein 50, Rotterdam, The Netherlands. [email protected]

  • PMID:

    17823601

  • DOI:

    10.1038/ncpuro0874

Review

Joop P van de Merwe.

Nat Clin Pract Urol.

2007 Sep.

. 2007 Sep;4(9):484-91.

doi: 10. 1038/ncpuro0874.

Author

Joop P van de Merwe 
1

Affiliation

  • 1 Erasmus MC, University Medical Center Rotterdam, Departments of Immunology and Internal Medicine, Dr Molewaterplein 50, Rotterdam, The Netherlands. [email protected]

  • PMID:

    17823601

  • DOI:

    10.1038/ncpuro0874

Abstract

The cause of interstitial cystitis, a chronic disease that affects the bladder, is unknown. Autoantibodies, such as those against nuclear and bladder epithelium antigens, have been found in patients with interstitial cystitis, but these are likely to be secondary to the disease. No data support a direct causal role of autoimmune reactivity in the pathogenesis of interstitial cystitis. Indirect evidence, however, does support a possible autoimmune nature of interstitial cystitis, such as the strong female preponderance and the clinical association between interstitial cystitis and other known autoimmune diseases within patients and families. The strongest association occurs between interstitial cystitis and Sjögren’s syndrome. Increasing evidence suggests a possible role of autoantibodies to the muscarinic M3 receptor in Sjögren’s syndrome. The M3 receptor is also located on the detrusor muscle cells of the bladder and mediates cholinergic contraction of the urinary bladder and other smooth muscle tissues. Autoantibodies to the M3 receptor might be important in both the early noninflammatory and the late inflammatory features of interstitial cystitis.

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ICS 2021 Abstract #455 The severity of bladder pain syndrome in patients with autoimmune disease


The severity of bladder pain syndrome in patients with autoimmune disease


Vogiatzi G

1, Akrivou D2, Skriapas K2, Samarinas M2
Abstract 455


On Demand Pelvic Pain Syndromes / Sexual Dysfunction

Scientific Open Discussion Session 29

On-Demand
Pain, Pelvic/Perineal Painful Bladder Syndrome/Interstitial Cystitis (IC) Questionnaire


1. General Hospital of Larissa, Department of Internal Medicine, 2. General Hospital of Larissa, Urology Department



G

Georgia Vogiatzi






Edit Abstract






Abstract Centre



Abstract


Hypothesis / aims of study 

Bladder Pain Syndrome (BPS) is a clinical diagnosis that relies on symptoms of pain in the bladder and pelvis, including also urgency and frequency [1].  BPS has been defined as chronic (>6 months) pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder accompanied by at least one other urinary symptom such as persistent urge to void or frequency [2]. The International Continence Society (ICS) has defined BPS as the complaint of suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and night-time frequency, in the absence of proven urinary infection or other obvious pathology [9]. ICS, also, reserved the diagnosis Interstitial Cystitis (IC) to patients with typical cystoscopic and histological features. However, it has been shown that only a fraction of patients with BPS fulfils this definition. Apart from the relationship of BPS with overactive bladder (OAB) symptoms, there is some literature supporting a correlation of BPS with systemic diseases. In our study we investigated the possible association of BPS with autoimmune syndromes.


Study design, materials and methods 

This is an observational comparative study including patients from the Pelvic Pain Syndrome specific outpatients’ office of the Urology Department and the Internal Medicine outpatients’ office of our hospital.  Patients have been allocated into two groups. Group A included patients with BPS and an autoimmune disease in their medical history, while Group B included those with BPS but without autoimmune disease. All patients have been evaluated with visual analogue scale (VAS), Interstitial cystitis symptom index (ICSI) and Interstitial cystitis problem index (ICPI) as separate parts of O’Leary- Saint score (OSS). Additionally, all patients underwent a cystoscopy under general anesthesia in order maximum bladder capacity (MBC) to be evaluated. Patients with neurological medical history and diabetes mellitus have been excluded from the study. The collected data have been statistically analyzed with the use of SPSS v.24 and the appropriate methods for non-parametric samples.


Results 

The study enrolled 26 patients, 16 women and 10 men with a mean age of 45.5 years old. Group A included 14 patients (8 women and 6 men) and Group B 12 (8 women and 4 men).  Regarding autoimmune diseases, 6 patients had rheumatoid arthritis, 4 had Sjogren Syndrome, 2 had Wilson Disease, 1 had rheumatic polymyalgia and 1 was with Lupus. In Group A the mean VAS was 8.5 for the whole patients with a prevalence for women comparing to men, documented with a statistical difference (p= 0.02). In Group B the mean VAS was 7.25 without specific differences between genders. VAS has been found statistically different between two groups (p= 0.01). Considering ICSI, patients of Group A have documented a mean score of 16.5, but there was a significant difference between genders with women to be evaluated with higher scores when compared to men (p= 0.03). In Group B, the mean ICSI was 13.25 without any difference inside genders subgroup. In parallel, the evaluation of ICPI resulted to a mean score of 12.5 for Group A with a statistical prevalence for women (p= 0.03), while the mean score for ICPI in Group B has been measured at 10.25 without difference between genders. Both indexes have been found to be statistically different comparing the two groups (p= 0. 03 and p= 0.02 respectively). Inside Group A, it seemed that patients with Sjogren Syndrome documented the highest scores among all other with autoimmune diseases in the evaluation questionnaires (mean VAS= 9, mean ICSI= 17.5, mean ICPI= 13.5). Cystoscopy revealed only one case with Hunner’s lesion, in a patient with Sjogren Syndrome. Also, the mean MBC under anesthesia was 550ml for patients of Group A and 575ml for those of Group B without any statistical difference between them.


Interpretation of results 

Bladder pain syndrome may have a basic research association with autoimmune diseases, but their clinical correlation has to be confirmed. In our study, patients with both BPS and autoimmune disease have been found to have more severe lower urinary tract symptoms and pain than those with BPS alone. Moreover, women seem to suffer more than men. The limitation of our study is that the difference among autoimmune diseases, regarding lower urinary tract dysfunction and pain, cannot be evaluated due to the small recruitment.


Concluding message 

Patients with bladder pain syndrome seem to have a more severe lower urinary symptoms and discomfort when there is a medical history of a concomitant autoimmune disease.


References 

  1. Van De Merwe, J., Nordling, J., Bouchelouche, K. et.al: Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an essic proposal. Eur Urol, 53: 60, 2008.
  2. Hanno, P., Nordling, J., van Ophoven, A.: What is new in bladder pain syndrome/interstitial cystitis? Curr Opin Urol, 18: 353, 2008
  3. Abrams, P. H., Cardozo, L., Fall, M., et al.: The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourology and Urodynamics, 21: 167, 2002.


Disclosures


Funding none Clinical Trial No Subjects Human Ethics Committee Scientific Council of General Hospital of Larissa Helsinki Yes Informed Consent Yes


20/06/2023 21:25:45

Ecoantibiotics – Interstitial cystitis: autoimmune or infectious?

According to the classification, cystitis can be of infectious and non-infectious nature (chemical, autoimmune, radiation, after radiation therapy), it can be acute and chronic.

According to the type of inflammatory process, the following types of cystitis are distinguished:

  • catarrhal
  • hemorrhagic
  • ulcerative
  • phlegmonous
  • necrotic
  • interstitial
  • polyposis.

Interstitial cystitis is of particular interest. This is a clinical syndrome, the causes of which are still being discussed. The medical community considers the most likely cause of interstitial cystitis to be autoimmune damage to urothelial cells and a violation of the innervation of the bladder wall.

There are two forms of the disease: ulcerative (with the formation of an ulcer in the bladder) and non-ulcerative.

Symptoms that characterize interstitial cystitis include chronic pelvic pain, painful frequent urination, including at night. All this leads to sexual dysfunction, psychological problems, neuroses and, ultimately, social maladaptation.

Predisposing factors for the development of interstitial cystitis include:

  • history of autoimmune diseases
  • bronchial asthma
  • irritable bowel syndrome
  • drug allergy
  • surgical interventions in the pelvic area, etc.

The treatment of interstitial cystitis is based on the following principles:

  • maintaining the integrity of the bladder epithelium
  • decreased neurogenic activation
  • prevention of the allergic cascade.

Groups of drugs used to treat this pathology include NSAIDs, antihistamines, anticholinergics and antispasmodics. is a process that requires high adherence to treatment from patients. In case of secondary infection, antibiotics are prescribed.

Secondary infection in interstitial cystitis

The most common causative agent of acute infectious inflammation of the bladder, including secondary – against the background of existing interstitial cystitis, is the gram-negative flora of the intestinal group, in particular E. coli.

Factors predisposing to the development of this disease are:

  • anatomical features of the structure (wide and short urethra in women)
  • proximity to natural reservoirs of infection
  • frequency and nature of sexual intercourse
  • violations of urodynamics due to the presence of concomitant diseases (prostate adenoma in men).

Among the most common symptoms of acute infectious cystitis are pain above the pubis, painful frequent urination. In uncomplicated acute cystitis, there is no fever, chills, weakness, loss of appetite, and other general symptoms. Their appearance will indicate the addition of complications and requires an immediate response from the medical worker.

In case of untimely and inadequate treatment, acute cystitis may become chronic.

Chronicity of the process is facilitated by:

  • the presence of resistant forms of uropathogenic microorganisms
  • violation of urine outflow
  • the presence of foreign bodies in the bladder (stones).

The diagnosis of cystitis is made on the basis of the patient’s complaints of frequent and painful urination, history, and laboratory results.

In the general analysis of urine, the presence of leukocytes and bacteria can be noted. A clinical blood test is characterized by classic signs of inflammation: an increase in the number of leukocytes, a shift of the leukoformula to the left, and an increase in ESR.

Urine culture and antibiotic susceptibility testing recommended to identify the causative agent. Among the instrumental methods, ultrasound of the bladder is of the greatest importance. In the acute period of infection, cystoscopy is not recommended.

In the case of a chronic course of the process, urine culture for Mycobacterium tuberculosis and cystoscopy are additionally prescribed.

Treatment of bacterial complications of interstitial cystitis

Etiopathogenetic treatment of cystitis is based on the elimination of provoking factors and the appointment of etiotropic antibiotic therapy. The drugs of choice are antibiotics from the group of fluoroquinolones.

Given the negative impact of antibacterial drugs on the natural intestinal microflora, it is advisable to use the most gentle drugs in patients with interstitial cystitis. So, ecoantibiotics Ecolevid (levofloxacin) and Ecocifol (ciprofloxacin) contain a prebiotic component – anhydro lactulose, which contributes to the preservation of normal intestinal microflora. The presence of an additional component helps the patient to better tolerate antibiotic treatment and reduces the likelihood of developing negative effects from the gastrointestinal tract.

In case of chronic cystitis, antispasmodics, local therapy (instillations of medicinal solutions into the bladder) are also prescribed, if indicated, immunotherapy is performed.

Painful bladder syndrome in women ᐉ more details on the website

Painful Bladder Syndrome (BPS) is common among women of all ages. You can also find the name interstitial cystitis. This is an inflammation of the bladder, but unlike ordinary cystitis, it is usually not associated with infections. Such a disease is extremely unpleasant and definitely needs treatment, otherwise the price of a neglected syndrome will be too high.

Summary of

Patients who have suffered from interstitial cystitis most often describe the disease as “toilet addiction”. Indeed, the most frequent and accurate symptom is a sudden and sharp urge to urinate. This symptom is especially pronounced at night. The following symptoms of the manifestation of the disease are also distinguished:

  • pain in the lower abdomen, especially when filling the bladder;
  • painful urination;
  • feeling of incomplete emptying of the bladder;
  • discomfort in the womb;
  • possible pain during sex and blood when urinating.

The causes of the syndrome are varied. It can be hypothermia, decreased immunity, circulatory disorders of the bladder, inflammation of the genital organs, hormonal changes, autoimmune diseases, stress. Also, the consumption of salty, spicy and fatty foods, alcohol, and certain foods can become a provoking factor.

Sometimes the symptoms of the disease go away on their own, but in most cases the acute phase recurs. Therefore, when the first signs appear, be sure to consult a doctor for help. Prolonged course of the disease can lead to serious health problems.

Methods for diagnosing SBPS

To diagnose painful bladder syndrome, a comprehensive examination is necessary. It includes:

  1. Clinical analysis and urine culture
  2. Ultrasound of the genitourinary system
  3. Cystometry
  4. Endoscopy of the bladder
  5. Taking swabs from the urethra, vagina
  6. Gynecological consultation.

According to the results of the examination and tests, appropriate treatment is prescribed.

What does self-treatment lead to?

Doctors urge not to start self-treatment in any case. Often, patients confuse BPS with cystitis and take antibiotics. This treatment may be ineffective and provoke intestinal or vaginal dysbiosis and lead to other bad consequences. Also, taking the wrong drugs can lead to the appearance of forms of bacteria that are resistant to therapy and complicate treatment.

Treatments for painful bladder syndrome

Methods of treatment are individual and selected by a doctor. Most often, patients are prescribed complex therapy, which includes:

  1. Diet. At the time of treatment, it is worth giving up fried, salty and spicy foods, sweets. You need to drink more water, fruit drinks, and also eat fresh vegetables, berries and fruits, especially those that have a diuretic effect. You can eat dairy products.
  2. Medical therapy. Usually prescribe drugs that relieve excessive excitability of the bladder, painkillers, anti-inflammatory drugs, antidepressants and antihistamines.
  3. Topical therapy. This is the introduction into the bladder of drugs, hyaluronic acid and other drugs to alleviate the condition and stabilize the bladder.
  4. Magnetic laser therapy – external or internal.

Doctors also often have to deal with complications that arise during the long course of the disease. This is the destruction of the protective membrane of the bladder, spasm of the pelvic floor muscles, fibrosis, irritable bowel syndrome, sexual disorders and other consequences.

Treatment of interstitial cystitis is usually long and requires patience.