Subject(s)
Arthritis, Rheumatoid , Immunoglobulin G , Liver Cirrhosis, Biliary , Receptors, Tumor Necrosis Factor , Tumor Necrosis Factor-alpha , Aged , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/immunology , Arthritis, Rheumatoid/physiopathology , Etanercept , Female , Hand Joints/pathology , Humans , Immunoglobulin G/administration & dosage , Immunoglobulin G/adverse effects , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Liver Cirrhosis, Biliary/complications , Liver Cirrhosis, Biliary/diagnosis , Liver Cirrhosis, Biliary/drug therapy , Liver Cirrhosis, Biliary/immunology , Liver Cirrhosis, Biliary/physiopathology , Liver Function Tests/methods , Receptors, Tumor Necrosis Factor/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Recombinant Fusion Proteins/adverse effects , Treatment Outcome , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Tumor Necrosis Factor-alpha/immunologyABSTRACT
In rheumatoid arthritis (RA), disease activity is generally determined by the joint involvement, but the treatment outcome is often influenced by extra-articular manifestations. Authors present a 74-year-old female patient's case history, who was treated with seropositive RA. Marked disease activity was observed even following combined traditional disease-modifying antirheumatic drug (DMARD) treatment (disease activity score in 28 joints (DAS28) = 6.6). Therefore, the patient received TNF-α antagonist therapy. Golimumab was administered subcutaneous (SC) once monthly which resulted in significant improvement in both clinical and laboratory signs (DAS28 = 3:43). However, the follow-up chest x-ray indicated multiple intrapulmonary foci and enlarged lymph nodes. Biopsies and histology excluded malignancy; rheumatoid nodules were confirmed. Anti-TNF therapy was discontinued and tocilizumab treatment was initiated. The IL-6 receptor inhibitor suppressed arthritic activity, and 2 months later, the follow-up chest x-ray showed a regression of chest nodules. Our cases, as well as reports from other centers, suggest that TNF blockade may induce rheumatoid nodulosis and the use of alternative biologics may be feasible as further treatment of RA.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Biological Therapy/adverse effects , Receptors, Interleukin-6/antagonists & inhibitors , Rheumatoid Nodule/drug therapy , Rheumatoid Nodule/etiology , Rheumatoid Nodule/pathology , Tumor Necrosis Factor-alpha/adverse effects , Aged , Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/drug therapy , Female , Humans , Lung/diagnostic imaging , Radiography , Treatment Outcome , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
Ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are two distinguished representatives of inflammatory rheumatic diseases. The two diseases differ significantly in their etiology, pathology, clinical signs, and in the nature of articular manifestations. Their association has been a rarity in the literature. Here, authors describe a case of a 55-year-old female patient with AS associated with RA. Her spinal symptoms started in 1979, and the diagnosis of AS was established based on the typical clinical picture and X-ray. She developed severe spinal deformity during the next decades. In 2005, peripheral polyarthritis developed, although neither the diagnosis nor the treatment was modified. In 2007, authors diagnosed seropositive RA. Therapy included anti-inflammatory therapy and traditional disease-modifying agents, eventually followed by biological therapy.
