Department of Gastroenterology, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France.
Int J Colorectal Dis. 2020 Jun;35(6):1141-1148. doi: 10.1007/s00384-020-03581-3. Epub 2020 Apr 15.
Extra-intestinal manifestations (EIM) are common in inflammatory bowel diseases (IBD) and may affect up to 40% of the patients during the course of the disease. Peripheral arthralgia (PA) is by far the most common EIM. To date, TNFα inhibitors are the most established treatment for EIMs in IBD. Infliximab (IFX) trough levels (TL) and anti-IFX antibodies (ATI) are correlated with multiple outcomes in IBD such as clinical response and remission, mucosal healing, fistular healing, and more. So far, a correlation between PA and IFX TL\ATI has not been evaluated.
This retrospective study included IBD patients followed by the gastroenterology department of Sheba Medical Center. Patients with active PA at onset of IFX treatment were included. IFX TL and ATI were evaluated at week 6, 14, and 26 and correlated with PA persistence.
Forty patients (37 Crohn's and 3 ulcerative colitis) with IBD-related PA were included. The overall prevalence of PA was 55% (22/40), 42.5% (17/40), and 55% (22/40) after 6, 14, and 26 weeks, respectively. IFX trough drug levels were not associated with reported PA at week 6 [median, 11.8 μg/ml (IQR 6.6-15.5) vs 10.05 μg/ml (IQR 7.35-12.87), p = 0.56], week 14 [median, 4.7 μg/ml (IQR 2.3-7) vs 3.1 μg/ml (IQR 1.35-7.35), p = 0.55], and week 26 [median, 3 μg/ml (IQR 1.15-5.17) vs 3.4 μg/ml (IQR 0.13-6.75), p = 0.94]. Detectable ATI were significantly more prevalent in patients with PA than in patients without PA at week 26 [11/22 (50%) vs 3/18 (16.7%), p = 0.028].
In patients with IBD-related PA, ATI are associated with an increased risk of persistence of PA. No direct correlation was demonstrated between IFX TL and persistence of PA.
肠道外表现（EIM）在炎症性肠病（IBD）中很常见，在疾病过程中，多达 40%的患者可能会受到影响。外周关节炎（PA）是迄今为止最常见的 EIM。迄今为止，TNFα抑制剂是 IBD 中 EIM 的最有效治疗方法。英夫利昔单抗（IFX）谷浓度（TL）和抗 IFX 抗体（ATI）与 IBD 的多种结局相关，如临床反应和缓解、黏膜愈合、瘘管愈合等。到目前为止，尚未评估 PA 与 IFX TL\ATI 之间的相关性。
本回顾性研究纳入了 Sheba 医疗中心胃肠病科随访的 IBD 患者。纳入在 IFX 治疗开始时存在活动期 PA 的患者。在第 6、14 和 26 周时评估 IFX TL 和 ATI，并与 PA 持续存在相关联。
40 例（37 例克罗恩病和 3 例溃疡性结肠炎）IBD 相关 PA 患者纳入本研究。PA 的总体患病率分别为第 6、14 和 26 周时的 55%（22/40）、42.5%（17/40）和 55%（22/40）。第 6 周时，IFX 谷药物浓度与报告的 PA 无相关性[中位数，11.8μg/ml（IQR 6.6-15.5）与 10.05μg/ml（IQR 7.35-12.87），p=0.56]，第 14 周时[中位数，4.7μg/ml（IQR 2.3-7）与 3.1μg/ml（IQR 1.35-7.35），p=0.55]，第 26 周时[中位数，3μg/ml（IQR 1.15-5.17）与 3.4μg/ml（IQR 0.13-6.75），p=0.94]。第 26 周时，有 PA 的患者中可检测到 ATI 的比例明显高于无 PA 的患者[11/22（50%）比 3/18（16.7%），p=0.028]。
在 IBD 相关 PA 患者中，ATI 与 PA 持续存在的风险增加相关。IFX TL 与 PA 的持续存在之间未显示出直接相关性。
