Emergence of Crohn's Disease During Treatment with the Anti-Tumor Necrosis Factor Agent Etanercept for Ankylosing Spondylitis: Possible Mechanisms of Action

被引：44

作者：

Haraoui, Boulos ^{[1
]}

Krelenbaum, Marilyn ^{[2
]}

机构：

[1] Univ Montreal, Ctr Hosp, Hop Notre Dame, Montreal, PQ H2L 4M1, Canada

[2] Hlth Care Res & Med Commun, Montreal, PQ, Canada

来源：

SEMINARS IN ARTHRITIS AND RHEUMATISM | 2009年 / 39卷 / 03期

关键词：

Crohn's disease; inflammation; ankylosing spondylitis; tumor necrosis factor-alpha antagonist; biologic therapy; inflammatory bowel disease; mechanism of action; FACTOR-ALPHA; BOWEL INFLAMMATION; INTERFERON-GAMMA; UP-REGULATION; DOUBLE-BLIND; INFLIXIMAB; APOPTOSIS; ARTHRITIS; EFFICACY; SPONDYLOARTHRITIS;

D O I：

10.1016/j.semarthrit.2008.06.004

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives: To report on the clinical evolution of a patient with ankylosing spondylitis (AS) treated with etanercept who subsequently developed Crohn's disease, to review the literature for similar cases, and to discuss possible mechanisms responsible for these observations. Methods: We describe the medical history, diagnostic tests, and disease progression of a 26-year-old man with AS who developed the clinical manifestations of Crohn's disease after 16 months of successful treatment of his rheumatologic symptoms with etanercept. A Medline search, as well as cases presented in abstract form at European League Against Rheumatism (EULAR) and American College of Rheumotology (ACR) meetings, describing emergent bowel symptoms in patients treated with etanercept was undertaken. Results: Eight other cases were identified, with gastrointestinal symptoms appearing after a few weeks to several years, while receiving etanercept treatment. These observations raise the possibility that etanercept unmasks inflammatory bowel disease in patients with AS whose gastrointestinal symptoms were silent. Conclusion: The reactivation or the unmasking of gastrointestinal symptoms during etanercept treatment raises the issue of differences between etanercept and the other antitumor necrosis factor monoclonal antibodies in their molecular structure, tumor necrosis factor neutralizing effect, mode of administration, and pharmacokinetics that may account for these observations. (C) 2009 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 39:176-181

引用

页码：176 / 181

页数：6

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