Virupannavar Shanti, Brandau Anthony, Guggenheim Carla, Laird-Fick Heather
Internal Medicine, Michigan State University, 138 Service Road, A225 Clinical Center, East Lansing, MI 48825, USA.
Internal Medicine and Hematology/Oncology, McLaren of Greater Lansing, 401 West Greenlawn Avenue, Lansing, MI 48910, USA.
Case Rep Rheumatol. 2014;2014:801072. doi: 10.1155/2014/801072. Epub 2014 May 15.
Tumor necrosis factor α (TNF α ) inhibitors are commonly used for treatment of aggressive rheumatoid arthritis and other rheumatic diseases. Etanercept is one of the medications approved for treatment of rheumatoid arthritis. Though many studies have documented the safety and efficacy of these medications, evidence for adverse effects is emerging including cancer, infections, and cardiovascular disease. There have been studies showing that these medications induce autoantibody production, including antinuclear antibodies and anti-dsDNA antibodies. Limited data exists, however, regarding induction of antiphospholipid antibodies (APLs) by TNF α inhibitors, including anticardiolipin antibodies (ACLs), lupus anticoagulant (LAC), and anti- β 2-glycoprotein I (anti- β 2 GPI), or an association between antibody development and clinical manifestations. In this case series, we describe five patients who developed venous thromboembolism (VTE) and APLs while receiving etanercept therapy. All five of our patients met the criteria for diagnosis of APS after receiving etanercept. Our case series supports the association between etanercept, APLs, and VTE. We believe that testing for APLs prior to initiation of anti-TNF therapy is reasonable, given this relationship and the risks associated with VTE.
肿瘤坏死因子α（TNFα）抑制剂常用于治疗侵袭性类风湿关节炎和其他风湿性疾病。依那西普是被批准用于治疗类风湿关节炎的药物之一。尽管许多研究记录了这些药物的安全性和有效性，但包括癌症、感染和心血管疾病在内的不良反应证据正在出现。有研究表明这些药物会诱导自身抗体产生，包括抗核抗体和抗双链DNA抗体。然而，关于TNFα抑制剂诱导抗磷脂抗体（APL），包括抗心磷脂抗体（ACL）、狼疮抗凝物（LAC）和抗β2糖蛋白I（抗β2GPI）的数据有限，或者抗体产生与临床表现之间的关联的数据有限。在这个病例系列中，我们描述了5例在接受依那西普治疗时发生静脉血栓栓塞（VTE）和APL的患者。我们所有5例患者在接受依那西普治疗后均符合抗磷脂综合征（APS）的诊断标准。我们的病例系列支持依那西普、APL和VTE之间的关联。鉴于这种关系以及与VTE相关的风险，我们认为在开始抗TNF治疗之前检测APL是合理的。
