Department of Rheumatology and Allergy, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan.
Division of Rheumatology, Center for Antibody and Vaccine Therap, IMSUT Hospital, Institute of Medical Science, The University of Tokyo, Japan.
Intern Med. 2020 Oct 15;59(20):2611-2618. doi: 10.2169/internalmedicine.4646-20. Epub 2020 Jul 7.
A 65-year-old Japanese woman, who was diagnosed with rheumatoid arthritis and Sjögren's syndrome with various autoantibodies including anti-DNA antibody, developed bullous pemphigoid (BP) and hematological abnormalities like lupus erythematosus after adalimumab therapy. The discontinuation of adalimumab resolved those disorders but polyarthritis thereafter relapsed. The introduction of abatacept was not effective, but tocilizumab was found to be effective for polyarthritis, however, thereafter both bullous disease and severe pancytopenia developed. Discontinuation of tocilizumab was effective, but polyarthritis again developed, and baricitinib resolved it. There is an increasing number of reports of drug-induced BP and lupus erythematosus, and biologics might trigger an alteration in the pathophysiological/clinical course of rheumatic disorder.
一位 65 岁的日本女性，被诊断患有类风湿关节炎和干燥综合征，伴有多种自身抗体，包括抗 DNA 抗体，在阿达木单抗治疗后出现大疱性类天疱疮（BP）和类似红斑狼疮的血液学异常。停止阿达木单抗治疗后这些异常得到了缓解，但随后多发性关节炎又复发了。阿巴西普的引入没有效果，但托珠单抗对多发性关节炎有效，但随后出现大疱病和严重全血细胞减少。停止托珠单抗治疗有效，但多发性关节炎再次发作，巴瑞替尼缓解了病情。越来越多的报告表明药物会导致 BP 和红斑狼疮，生物制剂可能会改变风湿性疾病的病理生理/临床过程。
