Ambrosio Maria Luisa, Monami Matteo, Sati Lavinia, Marchionni Niccolò, Di Bari Mauro, Mannucci Edoardo
Geriatric Cardiology, Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, 50141, Florence, Italy.
Acta Diabetol. 2014 Aug;51(4):673-4. doi: 10.1007/s00592-013-0525-3. Epub 2013 Oct 25.
Occasional cases of bilateral, symmetrical, seronegative polyarthritis have been reported in patients treated with dipeptidyl peptidase-4 inhibitors (Crickx et al. in Rheumatol Int, 2013). We report here a similar case observed during treatment with a GLP-1 receptor agonist. A 42-year-old man with type 2 diabetes treated with metformin 1,500 mg/day and liraglutide 1.8 mg/day. After 6 months from the beginning of treatment, the patient complained of bilateral arthralgia (hands, feet, ankles, knees, and hips). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and leukocytes were increased. Rheumatoid factor, anticyclic citrullinated protein antibody, antinuclear antibodies, anti-Borrelia, and burgdorferi antibodies were all negative, and myoglobin and calcitonin were normal. Liraglutide was withdrawn, and the symptoms completely disappeared within 1 week, with normalization of ESR, CRP, fibrinogen, and leukocytes. Previously described cases of polyarthritis associated with DPP4 inhibitors had been attributed to a direct effect of the drugs on inflammatory cells expressing the enzyme. The present case, occurred during treatment with a GLP-1 receptor agonists, suggests a possibly different mechanism, mediated by GLP-1 receptor stimulation, which deserved further investigation.
在接受二肽基肽酶-4抑制剂治疗的患者中，曾有双侧对称性血清阴性多关节炎的偶发病例报道（Crickx等人，《国际风湿病学》，2013年）。我们在此报告1例在使用胰高血糖素样肽-1（GLP-1）受体激动剂治疗期间观察到的类似病例。一名42岁的2型糖尿病男性患者，正在接受每日1500毫克二甲双胍和1.8毫克利拉鲁肽的治疗。治疗开始6个月后，患者出现双侧关节痛（手部、足部、脚踝、膝盖和髋部）。红细胞沉降率（ESR）、C反应蛋白（CRP）和白细胞升高。类风湿因子、抗环瓜氨酸化蛋白抗体、抗核抗体、抗伯氏疏螺旋体抗体均为阴性，肌红蛋白和降钙素正常。停用利拉鲁肽后，症状在1周内完全消失，ESR、CRP、纤维蛋白原和白细胞恢复正常。先前描述的与二肽基肽酶-4抑制剂相关的多关节炎病例被认为是药物对表达该酶的炎症细胞产生直接作用所致。本病例发生在GLP-1受体激动剂治疗期间，提示可能存在由GLP-1受体刺激介导的不同机制，值得进一步研究。
