Prescott Kara, Costner Melissa, Cohen Stanley, Kazi Salahuddin
Internal Medicine Department, Rheumatic Diseases Division, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Am J Med Sci. 2007 Mar;333(3):137-9. doi: 10.1097/MAJ.0b013e3180312362.
Flares or onset of inflammatory bowel disease in association with immunosuppression has been reported in the literature.
We studied 4 cases of patients with rheumatic disease who developed or had a flare of ulcerative colitis either after initiation of or while taking a tumor necrosis factor-alpha inhibitor.
We identified 4 patients, three male and one female. Two of the male patients had a seronegative spondyloarthropathy and one had rheumatoid arthritis. The female patient had amyopathic dermatomyositis. Two of the 4 patients had ulcerative colitis prior to tumor necrosis factor-alpha treatment. Both of these patients had quiescent ulcerative colitis that flared after they began taking etanercept. Two patients developed de novo ulcerative colitis while taking a tumor necrosis factor-alpha inhibitor.
The data presented in these 4 cases supports a temporal relationship between initiating a tumor necrosis factor-alpha inhibitor and onset or flare of ulcerative colitis. These observations raise the possibility that tumor necrosis factor-alpha inhibitor therapy, which has been used as treatment for inflammatory bowel disease, may rarely be a factor in the development of disease.
文献中已报道炎症性肠病的发作或 flare 与免疫抑制相关。
我们研究了 4 例风湿性疾病患者，他们在开始使用或正在服用肿瘤坏死因子-α抑制剂后发生或出现了溃疡性结肠炎 flare。
我们确定了 4 例患者，3 名男性和 1 名女性。2 名男性患者患有血清阴性脊柱关节病，1 名患有类风湿性关节炎。女性患者患有无肌病性皮肌炎。4 例患者中有 2 例在肿瘤坏死因子-α治疗前患有溃疡性结肠炎。这两名患者在开始服用依那西普后，静止期的溃疡性结肠炎均出现 flare。2 例患者在服用肿瘤坏死因子-α抑制剂时新发溃疡性结肠炎。
这 4 例病例中的数据支持开始使用肿瘤坏死因子-α抑制剂与溃疡性结肠炎的发作或 flare 之间存在时间关系。这些观察结果增加了一种可能性，即一直被用作炎症性肠病治疗方法的肿瘤坏死因子-α抑制剂治疗可能很少是疾病发展的一个因素。
