Puertas-Abreu Eduardo, Polanco Elaudi Rodríguez, Azocar Miriam, Mundarain Luis Antonio, Nuñez-Sotelo Concepción Morelia, Montaño Rafael, Vivas Freddy Herrera, Noguera Zair Tovar, Marín Francisco, Bellorin Omar, Rivas José Gregorio, Toro Eduardo, Benzaquen Eugenia, Rauseo Mayra, Gutiérrez González Luis Arturo
Hospital Universitario de Caracas, HUC-UCV, Urb, Los Chaguaramos, Ciudad Universitaria, Caracas 1020, DC, Venezuela.
Int Arch Med. 2012 Feb 15;5(1):7. doi: 10.1186/1755-7682-5-7.
The anti-TNFα therapy has been since its approval by the FDA, along with nonsteroidal antiinflammatory drugs (NSAIDs), one of the most important therapies for control of spondyloarthritis (SpA). The onset of Lupus Like Syndrome (LLS) has been described in patients with rheumatoid arthritis (RA) treated with anti-TNFα therapy but there is little literature on the occurrence of this entity in patients with SpA.
We studied 57 patients with SpA who received more than 1 year of anti-TNFα therapy (infliximab, adalimumab or etanercept). Patients were analyzed for the development of LLS, in addition to measuring ANA levels ≥ 1:160 and Anti-dsDNA (measured by IIF).
In total, 7.01% of patients treated with anti-TNFα had titers of ANA ≥ 1:160, whereas 3.5% of patients had serum levels of dsDNA. However, only one patient (1.75%; n = 1) experienced clinical symptoms of LLS; this was a female patient with a history of psoriatic arthritis.
The presence of LLS secondary to anti-TNFα therapy in patients with SpA is observed less frequently compared with patients with RA. LLS was only detected in a patient with a history of psoriasis since youth, who developed psoriatic arthritis after 27 years of age and had received anti-TNFα therapy for > 2 years. This may be because LLS is an entity clearly associated with innate immunity, with little central role of B and T cells.
自美国食品药品监督管理局（FDA）批准以来，抗TNFα疗法一直是控制脊柱关节炎（SpA）的最重要疗法之一，与非甾体抗炎药（NSAIDs）并列。类风湿关节炎（RA）患者接受抗TNFα治疗时曾有狼疮样综合征（LLS）发作的报道，但关于SpA患者中出现该病症的文献较少。
我们研究了57例接受抗TNFα治疗超过1年的SpA患者（英夫利昔单抗、阿达木单抗或依那西普）。除了测量ANA水平≥1:160和抗双链DNA（通过间接免疫荧光法测量）外，还对患者进行了LLS发展情况的分析。
总体而言，接受抗TNFα治疗的患者中有7.01%的ANA滴度≥1:160，而3.5%的患者血清双链DNA水平升高。然而，只有1例患者（1.75%；n = 1）出现了LLS的临床症状；这是一名有银屑病关节炎病史的女性患者。
与RA患者相比，SpA患者中抗TNFα治疗继发LLS的情况较少见。仅在一名自幼有银屑病病史、27岁后发展为银屑病关节炎且接受抗TNFα治疗超过2年的患者中检测到LLS。这可能是因为LLS是一种与先天免疫明显相关的病症，B细胞和T细胞的核心作用较小。
