gastrins and Arthritis

Neuroendocrine tumors (NETs) represent uncommon tumors arising from the excessive proliferation of enterochromaffin-like (ECL) cells (so-called Kulchitsky cell). Gastric NETs (GNET) represent less than 2% of all NETs and less than 1% of all stomach neoplasms. In particular, gastric NETs type 1 (associated to chronic atrophic gastritis and hypergastrinaemia) is the more frequent one, accounting for 70-80% of all GNET. A macrocytic anemia is a frequent manifestation of GNET type 1. The possibility that macrocytic anemia appear during therapy with methotrexate (MTX) is widely documented. Similarly, MTX can determine gastric atrophy. We describe the case of a patient with rheumatoid factor-positive early arthritis (EA) in which the appearance of macrocytic anemia during treatment with MTX led to the recognition of a GNET type 1, until then asymptomatic. The endoscopic eradication of polypoid formations forming the GNET, the immediate suspension of MTX and therapy with octreotide long-action determined the complete remission of arthritis. This remission is maintained until today. According to our knowledge, the possibility that an EA may represent a paraneoplastic manifestation of GNET has never been described.

Topics: Anemia, Macrocytic; Antimetabolites, Antineoplastic; Antineoplastic Agents, Hormonal; Arthritis; Enterochromaffin Cells; Erythrocytes; Gastrins; Gastritis, Atrophic; Humans; Male; Methotrexate; Middle Aged; Neuroendocrine Tumors; Octreotide; Rheumatoid Factor; Stomach Neoplasms

The relation between the incidence of gastric ulceration, basal acid output and serum gastrin concentration was studied in the pyloric-ligated normal rat and the rat with established adjuvant disease (polyarthritis). Although there was no significant difference in either gastric secretions or basal acid output, serum gastrin was significantly higher in the adjuvant rat than in the normal rat, independent of the nutritional state of the animal. The incidence of the gastric lesions was eight times greater in adjuvant rats compared to controls in a 6-hour pyloric-ligation period. When the period of pyloric ligation was increased from 6 to 17 hr, there was 91% increase in gastric lesions in polyarthritic rats. Histopathology of the lesions in the polyarthritic rat showed diffuse and focal submucosal edema with polymorphonuclear inflammatory cell infiltration in the submucosa of the fundic and antral areas of the stomach. The increased susceptibility of the polyarthritic rat to gastric ulceration could be related to a combination of experimental stress and hypergastrinemia. Since similar elevations in serum gastrin have been reported in the rheumatoid arthritis in man, it is herein proposed that the polyarthritic rat could be used as a screening model for the evaluation of the ulcerogenicity potential of nonsteroidal anti-inflammatory drugs.

Topics: Animals; Arthritis; Arthritis, Experimental; Gastric Juice; Gastrins; Male; Models, Biological; Rats; Stomach; Stomach Ulcer; Stress, Physiological; Time Factors

The elevation of plasma immunoreactive gastrin known to occur during the induction of adjuvant-induced arthritis (Rooney et al., 1973) has been shown to be maximal at 7 days after injection. Gastrin administered exogenously accelerated and exacerbated the inflammatory joint disease. Some evidence has been presented that the endogenous immunoreactive gastrin had biological activity in terms of gastric acid secretion.

Topics: Animals; Arthritis; Arthritis, Experimental; Gastric Juice; Gastrins; Pentagastrin; Rats

A significant rise in immunoreactive gastrin in a proportion of patients with rheumatoid arthritis is confirmed. Such a rise does not seem to occur in other inflammatory or tissue destructive diseases. The patients with raised immunoreactive gastrin appear to form a separate population but the factors determining this separation remain obscure. Anti-inflammatory drugs, at least during short-term administration have no influence on immunoreactive gastrin concentrations.

Topics: Adult; Aged; Anti-Inflammatory Agents; Antigens; Arthritis; Arthritis, Rheumatoid; Female; Gastrins; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Myocardial Infarction; Osteoarthritis; Psoriasis; Radioimmunoassay; Spondylitis, Ankylosing; Tuberculosis, Pulmonary