CIC-Biotherapy 506, University Hospital St Jacques, Boulevard Fleming, 25000 Besançon, France.
Joint Bone Spine. 2012 Oct;79(5):457-63. doi: 10.1016/j.jbspin.2011.10.001. Epub 2011 Nov 15.
To describe cases of new onset of inflammatory bowel disease (IBD) in patients with inflammatory rheumatic disease (IRD) receiving anti-TNF-α therapy.
A call for observations of such cases was sent to members of the French "Club rhumatismes et inflammation". Only patients without intestinal symptoms before introduction of anti TNF-α agents were included.
During a 2-year period, 16 patients were declared: nine men and seven women, mean age 41.5 ± 17.4 years, 12 patients with ankylosing spondylitis, one with rheumatoid arthritis, one with psoriatic arthritis and two juvenile idiopathic arthritis with enthesitis related arthritis. Overall, 14 patients received etanercept and two had infliximab. The meantime frame between onsets of anti-TNF--α drugs and development of IBD was 29.3 ± 20.1 months. According to endoscopic and histological findings, IBD was classified as typical Crohn's disease in eight cases, Crohn's-like disease in six cases, indeterminate in one case and definite ulcerative colitis in one case. For all cases, each TNF-α blocking agent was discontinued and replaced by another monoclonal anti TNF-α antibody. After a mean follow up period of 23.4 ± 19.5 months, outcome was favorable without recurrent or flaring IBD.
Paradoxical IBD may occur during anti TNF-α therapy for inflammatory rheumatic disease, mostly in patients with spondylarthropathies while receiving etanercept, at a frequency estimated to 0.15% in the French patients with spondylarthropathies exposed to TNF-α antagonists. The IBD mainly corresponded to Crohn's or Crohn's-like disease. On the contrary, new onset IBD is less frequently observed in other cases of IRD and with other TNF--α blockers.
描述接受抗 TNF-α 治疗的炎症性风湿病（IRD）患者中新发炎症性肠病（IBD）的病例。
向法国“关节炎和炎症俱乐部”的成员发出了此类病例的观察请求。仅纳入在引入抗 TNF-α 药物之前无肠道症状的患者。
在 2 年期间，共报告了 16 例患者：9 名男性和 7 名女性，平均年龄 41.5±17.4 岁，12 例强直性脊柱炎，1 例类风湿关节炎，1 例银屑病关节炎和 2 例幼年特发性关节炎伴附着点炎。总体而言，14 例患者接受了依那西普治疗，2 例患者接受了英夫利昔单抗治疗。抗 TNF-α 药物开始使用与 IBD 发生之间的时间间隔为 29.3±20.1 个月。根据内镜和组织学发现，8 例 IBD 分类为典型克罗恩病，6 例为克罗恩病样疾病，1 例为不确定，1 例为明确溃疡性结肠炎。所有病例均停用每种 TNF-α 阻滞剂，并改用另一种单克隆抗 TNF-α 抗体。平均随访 23.4±19.5 个月后，结果良好，无 IBD 复发或加重。
在接受抗 TNF-α 治疗炎症性风湿病时，可能会发生矛盾性 IBD，主要发生在接受依那西普治疗的脊柱关节病患者中，在法国接受 TNF-α 拮抗剂治疗的脊柱关节病患者中，其估计发生率为 0.15%。IBD 主要对应于克罗恩病或克罗恩病样疾病。相反，在其他类型的 IRD 和使用其他 TNF-α 阻滞剂时，新发 IBD 的发生率较低。
