We had an interesting conversation that a patient today that we think prompts further investigation and research.
The patient is a 60 year old female with a diagnosis of a 10 year history of Ulcerative Colitis. Prior to FMT treatment she had 7-9 loose bowel movements per day. Today the patient underwent day 7 of a 10-day Faecal Microbiota Transplant program. During this morning’s procedure the patient revealed that she had been suffering from Enteropathic Arthritis (EA) for some considerable time. (See below for a brief explanation of EA courtesy of the Spondilitis Association of America).
Enteropathic (en-ter-o-path-ic) arthritis is a form of chronic, inflammatory arthritis associated with the occurrence of an inflammatory bowel disease (IBD), the two best-known types of which are ulcerative colitis and Crohn’s disease. About one in five people with Crohn’s or ulcerative colitis will develop enteropathic arthritis.
The most common areas affected by enteropathic arthritis are inflammation of the peripheral (limb) joints, as well as the abdominal pain and possibly bloody diarrhea associated with the IBD component of the disease. In some cases, the entire spine can become involved as well.
Is There a Cure?
Currently, there is no known cure for enteropathic arthritis but there are medications and therapies available to manage the symptoms of both the arthritis and bowel components of the disease.
Causes of Enteropathic Arthritis
Many people don’t realize that the gastrointestinal tract contains the largest immune system in the body. The immune system is the body’s natural defense against foreign invaders, and it is somehow altered in people who have these conditions. Some researchers believe that the long-lasting inflammation found in the intestines of people with IBD damages the bowel, which in turn may allow bacteria to enter the damaged bowel wall and circulate through the blood stream. The body’s reaction to these bacteria may cause other problems including inflammation in the joints and/or spine, skin sores and inflammation of the eyes. Currently this hypothesis is neither fully understood nor confirmed by rigorous scientific study.
The patient expressed that she has suffered the pain from the Enteropathic Arthritis for so long that living with it has become part of her life. This morning she realised that the pain from the EA had actually stopped sometime in the last day or two but she cannot be specific as the reduction in pain has actually caught her by surprise.
Whilst academics and physicians are fixated on very large patient numbers when reviewing trials and research, let us not forget the case of Ship’s Surgeon James Lind of the Royal Navy who carried out the very first medical clinical trial in 1747 on board ship. Lind was trialling the use of Vitamin C to cure Scurvy which was ubiquitous at the time. Lind’s sample size was an n of 6 (3 in treatment and 3 control). Lind’s work was considered seminal both at the time and endures today and remember, with only an n of 6. Our observation of a single patient who has remission of the pain of Enteropathic Arthritis following treatment with Fecal Microbiota Transplant therapy, does need more study and we would like to see more specific results, but under “Lind’s Law” it also cannot be written off.