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Emergence of severe spondyloarthropathy-related entheseal pathology following successful vedolizumab therapy for inflammatory bowel disease.
- Source :
-
Rheumatology . Jun2019, Vol. 58 Issue 6, p963-968. 6p. 1 Color Photograph, 1 Chart. - Publication Year :
- 2019
-
Abstract
- Objectives Vedolizumab (VDZ) blocks α4β7 integrin and is licenced for the treatment of IBD. It has been associated with mild SpA-related features, including sacroiliitis and synovitis. Herein we report a series of cases demonstrating the emergence of severe SpA-associated enthesitis/osteitis following successful IBD therapy with VDZ. Methods We evaluated 11 VDZ-treated patients with IBD across seven centres who developed severe active SpA and/or enthesopathy, with the aim of characterizing the VDZ-associated SpA or entheseal flares. Imaging features demonstrating particularly severe disease were recorded. Results De novo SpA developed in 9 of 11 patients and flare of known SpA in 2 patients, with 4 patients requiring hospitalization due to disease severity. Available data showed that one of seven cases were HLA-B27 positive. The median time from VDZ initiation to flare was 12 weeks, with IBD well controlled in 7 of 10 patients (no data for 1 patient) at flare. Severe SpA enthesitis/osteitis was evident on MRI or US, including acute sacroiliitis (n = 5), extensive vertebral osteitis (n = 1), peri-facetal oedema (n = 1) and isolated peripheral enthesitis (n = 3). Due to arthritis severity, VDZ was discontinued in 9 of 11 patients and a change in therapy, including alternative anti-TNF, was initiated. Conclusion Severe SpA, predominantly HLA-B27 negative, with osteitis/enthesitis may occur under successful VDZ treatment for IBD, including in subjects with prior anti-TNF therapy for intestinal disease. [ABSTRACT FROM AUTHOR]
- Subjects :
- *THERAPEUTIC use of monoclonal antibodies
*HOSPITAL care
*INFLAMMATORY bowel diseases
*INTESTINAL diseases
*MAGNETIC resonance imaging
*MONOCLONAL antibodies
*OSTEITIS
*SPONDYLOARTHROPATHIES
*TENDON injuries
*TUMOR necrosis factors
*ULTRASONIC imaging
*TERMINATION of treatment
*TREATMENT effectiveness
*SEVERITY of illness index
*CHEMICAL inhibitors
*THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 14620324
- Volume :
- 58
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Rheumatology
- Publication Type :
- Academic Journal
- Accession number :
- 136673222
- Full Text :
- https://doi.org/10.1093/rheumatology/key267