Department of Physical Medicine and Rehabilitation, Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1 Bagcilar, 34214, Istanbul, Turkey.
Department of Physical Medicine and Rehabilitation, Alsancak Nevvar Salih Isgoren State Hospital, Izmir, Turkey.
Rheumatol Int. 2018 Nov;38(11):2157-2162. doi: 10.1007/s00296-018-4165-3. Epub 2018 Oct 6.
Tumor necrosis factor (TNF)-α is a cytokine that plays a well-established, key role as a central mediator of inflammation and immune regulation. TNF-α and its receptors are suggested to play a critical role in a number of chronic inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (AS), juvenile chronic arthritis, and inflammatory bowel disease (IBD). TNF-α inhibitors are currently used in the treatment of these diseases. We report a 29-year-old male with AS who developed Crohn's disease while taking etanercept. Etanercept treatment was interrupted and a switch to a monoclonal antibody-based anti-TNF treatment using adalimumab was started, which induced a prompt improvement of the gastrointestinal symptoms. We indicate the immunodysregulatory and proinflammatory effects of etanercept and discuss the potential pathogenic mechanisms of the paradoxical effect of TNF-α inhibitors. We also review the related literature on new-onset IBD following anti-TNF treatment for AS.
肿瘤坏死因子（TNF）-α 是一种细胞因子，作为炎症和免疫调节的中心介质，其作用得到了充分的证实。TNF-α 及其受体被认为在许多慢性炎症性疾病中发挥着关键作用，包括类风湿关节炎、银屑病关节炎、强直性脊柱炎（AS）、青少年慢性关节炎和炎症性肠病（IBD）。TNF-α 抑制剂目前被用于这些疾病的治疗。我们报告了一例 29 岁男性 AS 患者，在接受依那西普治疗期间发生克罗恩病。中断了依那西普的治疗，并开始使用阿达木单抗进行基于单克隆抗体的抗 TNF 治疗，这迅速改善了胃肠道症状。我们提示了依那西普的免疫调节和促炎作用，并讨论了 TNF-α 抑制剂的这种矛盾作用的潜在发病机制。我们还回顾了关于抗 TNF 治疗 AS 后新发 IBD 的相关文献。
