University of Cyprus Medical School, Old road Nicosia Limassol 215/6, Nicosia, 2029, Republic of Cyprus.
Division of Rheumatology, University of Cyprus Medical School, Nicosia, Republic of Cyprus.
Rheumatol Int. 2021 Mar;41(3):671-675. doi: 10.1007/s00296-020-04767-2. Epub 2021 Jan 12.
Systemic sclerosis (SSc) is an autoimmune rheumatic disease characterised by vasculopathy, inflammation and fibrosis in multiple organs and occasionally coexists with rheumatic conditions, such as axial spondyloarthritis (axSpA). The aim of this study was to demonstrate the successful use of tofacitinib in SSc and axial spondylarthritis (axSpa), as a novel therapeutic agent; however, further studies are needed to elucidate the role of JAK inhibition in the treatment of both conditions. In this paper, we report a case of a 58-year-old woman with diffuse SSc who developed axSpA. The patient had a 10-year history of SSc and was treated with tocilizumab before the onset of lower back pain. The diagnostic evaluation included MRI that demonstrated bone marrow oedema in the sacroiliac joints, the HLA-B27 was positive, and given the inflammatory features of her back pain, she was diagnosed with axSpa. The biologic agent was switched into etanercept with an improvement of the back pain; however, the patient had a relapse of her skin manifestations. Given the treatment failure, we aim to treat the 2 coexisting conditions concurrently with tofacitinib, which led to symptom improvement. This case report is noteworthy, given the rarity of the coexistence of both conditions and the therapeutic challenges faced by the clinician. The online database MEDLINE/PubMed and Scopus where searched for articles published from inception to June 2020, using the terms "ankylosing spondylitis" AND "systemic sclerosis" OR "axial spondyloarthritis" AND "systemic sclerosis". Also, we searched the American College of Rheumatology and European League Against Rheumatism annual meeting abstracts from 2015 to 2019 using the same terms. As a result, we found 9 similar case reports. 9 case reports of patients with both conditions were identified through a literature review and we highlighted the differences and similarities between them. Also, we emphasise on intracellular signalling inhibitors as novel therapeutic targets in treating both conditions. Tofacitinib might be a novel therapeutic agent in the management of SSc and axSpA.
系统性硬化症（SSc）是一种自身免疫性风湿病，其特征为血管病变、炎症和纤维化多器官，偶尔与风湿性疾病共存，如轴性脊柱关节炎（axSpA）。本研究旨在展示托法替尼在 SSc 和轴性脊柱关节炎（axSpa）中的成功应用，作为一种新型治疗药物；然而，需要进一步研究来阐明 JAK 抑制在这两种疾病治疗中的作用。在本文中，我们报告了一例 58 岁女性弥漫性 SSc 患者并发 axSpA。该患者 SSc 病史 10 年，在出现下腰痛之前曾接受托珠单抗治疗。诊断评估包括 MRI 显示骶髂关节骨髓水肿，HLA-B27 阳性，鉴于她腰痛的炎症特征，诊断为 axSpa。生物制剂转换为依那西普后，腰痛改善；然而，患者出现皮肤表现复发。鉴于治疗失败，我们旨在同时使用托法替尼治疗这两种共存疾病，这导致症状改善。鉴于这两种疾病共存的罕见性以及临床医生面临的治疗挑战，该病例报告值得注意。在线数据库 MEDLINE/PubMed 和 Scopus 中使用“ankylosing spondylitis”和“systemic sclerosis”或“axial spondyloarthritis”和“systemic sclerosis”的术语，从成立到 2020 年 6 月搜索发表的文章。此外，我们还使用相同的术语搜索了美国风湿病学会和欧洲抗风湿病联盟 2015 年至 2019 年年会摘要。结果，我们发现了 9 篇类似的病例报告。通过文献复习共发现 9 例同时患有两种疾病的患者报告，并强调了它们之间的差异和相似之处。此外，我们还强调细胞内信号抑制剂作为治疗这两种疾病的新型治疗靶点。托法替尼可能是 SSc 和 axSpA 治疗的新型治疗药物。
