Edupuganti Srujan, Khine Su, Gupta Rohit, Yadav Deepesh, Singh Adiraj
Internal Medicine/Pediatrics, Michigan State University College of Human Medicine, Hurley Medical Center, Flint, USA.
Internal Medicine, Michigan State University College of Human Medicine, Hurley Medical Center, Flint, USA.
Cureus. 2023 Aug 20;15(8):e43825. doi: 10.7759/cureus.43825. eCollection 2023 Aug.
Juvenile idiopathic arthritis (JIA) is a common form of arthritis that occurs in children, typically with an onset before the age of 16 years. It can affect joints in any part of the body. As per the International League of Rheumatology, JIA is classified into systemic arthritis, oligoarthritis, extended oligoarthritis, polyarthritis (rheumatoid factor positive), polyarthritis (rheumatoid factor negative), enthesitis-related arthritis (ERA), juvenile psoriatic arthritis (JPsA), and . JIA is treated with disease-modifying antirheumatic medications (DMARDs), which include both nonbiologic agents like methotrexate (MTX) and biologic agents like inhibitors of tumor necrosis factor-alpha, interleukin-1 (IL-1), IL-6, and T-cell co-stimulation modulators. As per recent studies, in December 2021, Secukinumab, an IL-17A inhibitor, is one of the most recent biologic agents approved for active ERA and JPsA. A few reports have suggested Secukinumab is related to new-onset inflammatory bowel diseases (IBDs). We present a case of a 20-year-old female who was being treated with Secukinumab for JIA, and six months into therapy, she developed symptoms suggestive of Crohn's disease (CD). The diagnosis was confirmed with colonoscopy, histopathology, and radiology results. Her symptoms completely resolved four weeks after discontinuing Secukinumab and oral steroid therapy. The efficacy and side effects of Secukinumab have been studied mainly on middle-aged populations who were being treated for psoriasis and ankylosing spondylitis (AS); however, there is limited literature on younger populations. With this case report, we would like to highlight the possible relationship between the development of IBD and Secukinumab therapy in the adolescent population and emphasize the importance of regular screening for IBD in this population.
幼年特发性关节炎（JIA）是儿童期常见的一种关节炎形式，通常在16岁之前发病。它可影响身体任何部位的关节。根据国际风湿病联盟的分类，JIA分为全身型关节炎、少关节炎、扩展性少关节炎、多关节炎（类风湿因子阳性）、多关节炎（类风湿因子阴性）、附着点炎相关关节炎（ERA）、幼年型银屑病关节炎（JPsA）等。JIA的治疗使用改善病情抗风湿药物（DMARDs），其中包括甲氨蝶呤（MTX）等非生物制剂以及肿瘤坏死因子-α抑制剂、白细胞介素-1（IL-1）抑制剂、IL-6抑制剂和T细胞共刺激调节剂等生物制剂。根据最近的研究，在2021年12月，IL-17A抑制剂司库奇尤单抗是最新获批用于活动性ERA和JPsA的生物制剂之一。一些报告表明司库奇尤单抗与新发炎症性肠病（IBD）有关。我们报告一例20岁女性，她因JIA接受司库奇尤单抗治疗，治疗6个月后出现克罗恩病（CD）的症状。通过结肠镜检查、组织病理学和放射学检查结果确诊。停用司库奇尤单抗和口服类固醇治疗4周后，她的症状完全缓解。司库奇尤单抗的疗效和副作用主要在治疗银屑病和强直性脊柱炎（AS）的中年人群中进行了研究；然而，关于年轻人群的文献有限。通过本病例报告，我们想强调IBD的发生与青少年人群中司库奇尤单抗治疗之间可能存在的关系，并强调对该人群定期筛查IBD的重要性。
