SAT0229 INTESTINAL PERMEABILITY IN IGA-VASCULITIS IN ADULTS
Authors: Sergei Guliaev, Leonid Strizhakov, Sergey Moiseev, Ivan Gmoshinskii, Vladimir Mazo
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Primary IgA-vasculitis and inflammatory bowel diseases (IBD) share many clinical signs, such as abdominal syndrome, skin purpura and IgA-nephropathy. It may indicate a common pathogenetic background for both pathological conditions. One of the hypotheses to explain a common IgA abnormalities and clinical similarities between two conditions is rupture of intestinal barrier resulting in defective antigen exclusion at mucosal level and increased antigen absorption into systemic circulation. While increased intestinal permeability has been well established in IBD there are few reports addressing this issue in IgA-vasculitis. <h3>Objectives</h3> Evaluation of small intestinal permeability in IgA-vasculitis. We have also looked for correlation between this parameter and clinical activity of the disease. <h3>Methods</h3> Intestinal permeability was assessed in 34 adult patients having primary IgA-vasculitis. EULAR/PRINTO/PRES criteria [1] were used for making of diagnosis after thorough laboratory and instrumental screening aiming to exclude a secondary nature of disease, including upper and lower endoscopy. Skin purpura was present in all patients being mandatory diagnostic criterion. Arthritis/arthralgia were seen in 20 patients (58%). There were no patients with evident abdominal damage just before and during investigation, although 15 (44%) patients had transient abdominal pain in the history. Mild to moderate signs of renal involvement (hematuria and/or proteinuria) were seen in 16 (47%) patients without renal impairment. We have evaluated the gut permeability using ovalbumin (OVA) which has been measured in serum 3 hours after fasting oral intake of the two raw chicken eggs. The level of OVA in serum was measured using bivalent solid-phase immune-enzyme assay ("Sandwich-ELISA"). An increase of OVA in serum above 4 ng/ml was considered as the evidence of increased intestinal permeability. <h3>Results</h3> Totally, intestinal permeability to OVA was found to be increased in 20 of 34 patients (59%). In seventeen of twenty patients (85%) with increased intestinal permeability there were clinical sings of disease activity (skin purpura and/or arthritis and/or urinary abnormalities). To find out which pattern of clinical activity is best associated with increased intestinal permeability we have separately analyzed the level of OVA in patients with skin purpura, arthritis and urinary abnormalities correspondingly during remission and exacerbation of the process. Statistically significant difference (p&lt;0,05) of OVA level was found only in patients selected on the basis of skin purpura activity: at the moment of clinically evident skin purpura the median OVA level was much higher (50 ng/ml) than during periods with no skin purpura (5 ng/ml). The difference between the rate of increased intestinal permeability in patients with and without abdominal syndrome in the history was not statistically significant (p=0.87). <h3>Conclusion</h3> Results of our study may indicate a subclinical abdominal involvement in considerable part of patients with IgA-vasculitis, characterized with transient episodes of increased intestinal permeability. This phenomenon is chronologically related to disease activity, particularly to flare-up of the skin purpura. It could be speculated that this transient increase of intestinal permeability may result from mucosal inflammation which needs to be clarified in further investigations. <h3>Reference</h3> [1] Ozen Set al., EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010 May;69(5):798-806. <h3>Disclosure of Interests</h3> None declared