Verschueren P, Vandooren A K, Westhovens R
Department of Rheumatology, University Hospital Leuven, Belgium.
Clin Rheumatol. 2005 Feb;24(1):87-90. doi: 10.1007/s10067-004-1033-1. Epub 2004 Nov 23.
Diarrhoea and weight loss are frequently reported adverse events in rheumatoid arthritis (RA) patients receiving the disease-modifying antirheumatic drug (DMARD) leflunomide. According to the available literature these side effects occur mostly during the first 6 months of treatment, are rather mild and rarely lead to treatment withdrawal. In this report, we describe the clinical, endoscopic and histologic findings in two RA patients with severe diarrhoea and important weight loss more than 12 months after starting treatment with leflunomide. In both cases the symptoms were caused by colitis, but one had ulcerative and the other microscopic colitis. Despite treatment with budesonide the complaints only improved after withdrawal of leflunomide, making a causal relationship between this drug and the pathogenesis of colitis probable. The heterogeneous histopathological findings in these two patients, however, do not allow us to draw any definitive conclusions about the mechanism by which leflunomide causes diarrhoea and weight loss in RA patients. We conclude that persistent diarrhoea or weight loss in patients taking leflunomide can be more serious than what is previously reported in the literature. In such cases leflunomide treatment should be stopped and an endoscopic examination of the colon is recommended. Given the long half-life of this drug a washout procedure with cholestyramine should be considered whenever the problem is severe or persistent.
腹泻和体重减轻是接受抗风湿药物（DMARD）来氟米特治疗的类风湿关节炎（RA）患者中经常报告的不良事件。根据现有文献，这些副作用大多发生在治疗的前6个月，相当轻微，很少导致停药。在本报告中，我们描述了两名RA患者在开始使用来氟米特治疗12个月后出现严重腹泻和显著体重减轻的临床、内镜和组织学表现。在这两个病例中，症状均由结肠炎引起，但一个是溃疡性结肠炎，另一个是显微镜下结肠炎。尽管使用布地奈德治疗，但只有在停用后症状才有所改善，这使得该药物与结肠炎发病机制之间可能存在因果关系。然而，这两名患者不同的组织病理学表现，使我们无法就来氟米特导致RA患者腹泻和体重减轻的机制得出任何明确结论。我们得出结论，服用来氟米特的患者持续腹泻或体重减轻可能比文献中先前报道的情况更严重。在这种情况下，应停止来氟米特治疗，并建议对结肠进行内镜检查。鉴于该药物的半衰期较长，每当问题严重或持续时，应考虑使用消胆胺进行洗脱程序。
