Potential gastrointestinal Behcet's disease flare after treatment with anti-interleukin 17a therapy.

BACKGROUND: Behcet's disease (BD) is a systemic disease characterized by recurrent oral and genital ulcers. The underlying disease pathway likely involves interleukin (IL)-17 A, a proinflammatory cytokine that is implicated in Behcet's uveitis. Secukinumab is an anti-IL-17 A drug that may have an emerging role in the treatment of refractory BD. This is the first known case report of gastrointestinal BD flare up after anti-IL-17 A therapy. CASE PRESENTATION: We presented a case of BD with cutaneous and articular features being treated with secukinumab. After the third dose of loading secukinumab, the patient developed acute lower abdominal pain required hospital admission. Urgent computer tomography (CT) abdomen showed fatty stranding of caecum. Colonoscopy with caecal showed increased number of inflammatory cells in lamina propria. Secukinumab was stopped and patient was started on medium dose steroid. His abdominal symptoms resolved after treatment. CONCLUSIONS: This case report illustrates a case of gastrointestinal (GI) BD presenting as acute inflammatory colitis after the use of secukinumab. Therefore, anti-IL-17 A agents should be used cautiously in patients with GI BD, and preferably guided by a phenotype-tailored approach.

Risk of nonpulmonary infections requiring hospitalization in spondyloarthritis.

OBJECTIVES: To compare the risk of five nonpulmonary infections leading to hospitalization between spondyloarthritis (SpA) and nonspecific back pain (NSBP), and to identify the risk factors. METHODS: A total of 3018 patients with SpA and 2527 patients with NSBP were identified. Data from December 1995 to June 2019 was retrieved from a centralized electronic medical record system. The date of onset of five types of nonpulmonary infections including: urinary tract infection (UTI), skin infection, gastroenteritis (GE), septic arthritis, and pancreato-hepatobiliary tract infection were identified. Demographic data, comorbidities, and medications used were also retrieved. Comparative risk of each type of infection between SpA and NSBP was determined using propensity score adjustment method. Cox regression model was used to identified risk factors. RESULTS: Patients with SpA were younger in age, predominantly male, with fewer comorbid diabetes mellitus (DM), renal impairment, and depression. Compared with NSBP, patients with SpA had higher risk of UTI (hazard ratio [HR] 1.91; p < .001), skin infection (HR 1.79; p < .001), and septic arthritis (HR 4.57; p = .04). Risk of GE (HR 1.42; p = 1.00), and pancreato-hepatobiliary tract infection (HR 1.67; p = .06) were not increased. Infliximab was an independent risk factor for UTI (HR 2.21; p = .04). Duration of steroid therapy >6 months (HR 2.22; p < .001), smoker (HR 1.81; p < .001), and psoriasis (HR 2.47; p < .001) were risk factors for skin infection. CONCLUSION: SpA was associated with increased risk of UTI, skin infection, and septic arthritis. Infliximab, prolonged steroid therapy, smoking, and psoriasis were associated risk factors.

Management of isolated soleal and gastrocnemius vein thrombosis.

OBJECTIVE: The ideal treatment for hospitalized patients with isolated gastrocnemius and/or soleal venous thrombosis is unclear. Recommendations range from watchful waiting to full-dose anticoagulation. This study examines the effectiveness of practice patterns at a single institution as measured by progression of thrombus. METHODS: All consecutive inpatients with a duplex scan diagnosis of isolated gastrocnemius and/or soleal vein clot (no other thrombotic segments were identified) and where two consecutive duplex studies (Intersocietal Commission for the Accreditation of Vascular Laboratories laboratory) were available for review were included. Two study groups were identified. TX group included patients who received anticoagulation treatment (heparin [fractionated or unfractionated], heparin substitutes, or warfarin) and the NoTX group included those who did not receive anticoagulant. Demographic, risk factors, comorbidities, length of hospital and intensive care unit stay, ambulatory status, and underlying hypercoagulable states were recorded. Thrombus progression rate in the two groups was compared using the χ2 test. A multivariate logistic regression model was used to examine the effect of anticoagulation treatment as well as the above demographic and clinical factors on the risk of progression. RESULTS: A total of 141 patients were included in the study, 76 of whom (54%) received anticoagulation. Forty-three patients (30%) had progression of their venous thrombosis: 33% (25/76) in the TX group and 28% (18/65) in the NoTX group (P=.50, by χ2 test). Results from multivariate logistic regression showed that treatment had no significant impact on outcome (Odds ratio=1.28, 95% confidence interval: 0.55-3.01; P=.57]. Patients with end-stage renal disease (6%), or stroke (13%) had significantly higher risk of progression (P<.05). None of the other clinical or demographic factors were significantly associated with the risk of progression. CONCLUSION: The results speak to the lack of efficacy of anticoagulation in the management of gastrocnemius and/or soleal vein thrombosis in the hospitalized patient. When measured by thrombus progression, treating these patients without anticoagulation appears to be equally efficacious as subjecting patients to anticoagulant therapy. A prospective, randomized clinical trial will be an important step in fully addressing this clinical dilemma.