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Onset of lupus like syndrome in patients with spondyloarthritis treated with anti-TNF-α.

Puertas-Abreu E, Polanco ER, Azocar M, Mundarain LA, Nuñez-Sotelo CM, Montaño R, Vivas FH, Noguera ZT, Marín F, Bellorin O, Rivas JG, Toro E, Benzaquen E, Rauseo M, Gutiérrez González LA, GRUPO GRUVES: grupo Venezolano para el Estudio de las Espondiloartrit - Int Arch Med (2012)

Bottom Line: In total, 7.01% of patients treated with anti-TNFα had titers of ANA ≥ 1:160, whereas 3.5% of patients had serum levels of dsDNA.However, only one patient (1.75%; n = 1) experienced clinical symptoms of LLS; this was a female patient with a history of psoriatic arthritis.This may be because LLS is an entity clearly associated with innate immunity, with little central role of B and T cells.

View Article: PubMed Central - HTML - PubMed

Affiliation: Hospital Universitario de Caracas, HUC-UCV, Urb, Los Chaguaramos, Ciudad Universitaria, Caracas 1020, DC, Venezuela. luiskakuro@gmail.com.

ABSTRACT

Background: The anti-TNFα therapy has been since its approval by the FDA, along with nonsteroidal antiinflammatory drugs (NSAIDs), one of the most important therapies for control of spondyloarthritis (SpA). The onset of Lupus Like Syndrome (LLS) has been described in patients with rheumatoid arthritis (RA) treated with anti-TNFα therapy but there is little literature on the occurrence of this entity in patients with SpA.

Methods: We studied 57 patients with SpA who received more than 1 year of anti-TNFα therapy (infliximab, adalimumab or etanercept). Patients were analyzed for the development of LLS, in addition to measuring ANA levels ≥ 1:160 and Anti-dsDNA (measured by IIF).

Results: In total, 7.01% of patients treated with anti-TNFα had titers of ANA ≥ 1:160, whereas 3.5% of patients had serum levels of dsDNA. However, only one patient (1.75%; n = 1) experienced clinical symptoms of LLS; this was a female patient with a history of psoriatic arthritis.

Conclusions: The presence of LLS secondary to anti-TNFα therapy in patients with SpA is observed less frequently compared with patients with RA. LLS was only detected in a patient with a history of psoriasis since youth, who developed psoriatic arthritis after 27 years of age and had received anti-TNFα therapy for > 2 years. This may be because LLS is an entity clearly associated with innate immunity, with little central role of B and T cells.

No MeSH data available.


Related in: MedlinePlus

Pericardial effusion with pleural effusion.
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Figure 2: Pericardial effusion with pleural effusion.

Mentions: There was not a high prevalence of LLS in patients with spondyloarthritis treated with anti TNFα therapy. In total, 7.01% of patients treated anti TNF had titers of ANA ≥ 1:160, whereas 3.5% of patients had serum levels of dsDNA. However, only one patient (1.75% n = 1) experienced clinical symptoms of LLS; this was a female patient with a history of psoriatic arthritis of 5 years of evolution, diagnosed with severe psoriasis since the age of 23 years. Besides that the patient was 50 years old and had received anti TNF therapy for over 2 years, she presented annular polycyclic lesions (Figure 1) on the anterior aspect of the arm (subacute cutaneous lupus) with polyserositis (Figure 2), which improved with anti TNF therapy discontinuation and low potency corticosteroid. This patient had ANA > 1:320, presence of anti-dsDNA by IIF and high titers by ELISA (≥ 25 IU/L).


Onset of lupus like syndrome in patients with spondyloarthritis treated with anti-TNF-α.

Puertas-Abreu E, Polanco ER, Azocar M, Mundarain LA, Nuñez-Sotelo CM, Montaño R, Vivas FH, Noguera ZT, Marín F, Bellorin O, Rivas JG, Toro E, Benzaquen E, Rauseo M, Gutiérrez González LA, GRUPO GRUVES: grupo Venezolano para el Estudio de las Espondiloartrit - Int Arch Med (2012)

Pericardial effusion with pleural effusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3295660&req=5

Figure 2: Pericardial effusion with pleural effusion.
Mentions: There was not a high prevalence of LLS in patients with spondyloarthritis treated with anti TNFα therapy. In total, 7.01% of patients treated anti TNF had titers of ANA ≥ 1:160, whereas 3.5% of patients had serum levels of dsDNA. However, only one patient (1.75% n = 1) experienced clinical symptoms of LLS; this was a female patient with a history of psoriatic arthritis of 5 years of evolution, diagnosed with severe psoriasis since the age of 23 years. Besides that the patient was 50 years old and had received anti TNF therapy for over 2 years, she presented annular polycyclic lesions (Figure 1) on the anterior aspect of the arm (subacute cutaneous lupus) with polyserositis (Figure 2), which improved with anti TNF therapy discontinuation and low potency corticosteroid. This patient had ANA > 1:320, presence of anti-dsDNA by IIF and high titers by ELISA (≥ 25 IU/L).

Bottom Line: In total, 7.01% of patients treated with anti-TNFα had titers of ANA ≥ 1:160, whereas 3.5% of patients had serum levels of dsDNA.However, only one patient (1.75%; n = 1) experienced clinical symptoms of LLS; this was a female patient with a history of psoriatic arthritis.This may be because LLS is an entity clearly associated with innate immunity, with little central role of B and T cells.

View Article: PubMed Central - HTML - PubMed

Affiliation: Hospital Universitario de Caracas, HUC-UCV, Urb, Los Chaguaramos, Ciudad Universitaria, Caracas 1020, DC, Venezuela. luiskakuro@gmail.com.

ABSTRACT

Background: The anti-TNFα therapy has been since its approval by the FDA, along with nonsteroidal antiinflammatory drugs (NSAIDs), one of the most important therapies for control of spondyloarthritis (SpA). The onset of Lupus Like Syndrome (LLS) has been described in patients with rheumatoid arthritis (RA) treated with anti-TNFα therapy but there is little literature on the occurrence of this entity in patients with SpA.

Methods: We studied 57 patients with SpA who received more than 1 year of anti-TNFα therapy (infliximab, adalimumab or etanercept). Patients were analyzed for the development of LLS, in addition to measuring ANA levels ≥ 1:160 and Anti-dsDNA (measured by IIF).

Results: In total, 7.01% of patients treated with anti-TNFα had titers of ANA ≥ 1:160, whereas 3.5% of patients had serum levels of dsDNA. However, only one patient (1.75%; n = 1) experienced clinical symptoms of LLS; this was a female patient with a history of psoriatic arthritis.

Conclusions: The presence of LLS secondary to anti-TNFα therapy in patients with SpA is observed less frequently compared with patients with RA. LLS was only detected in a patient with a history of psoriasis since youth, who developed psoriatic arthritis after 27 years of age and had received anti-TNFα therapy for > 2 years. This may be because LLS is an entity clearly associated with innate immunity, with little central role of B and T cells.

No MeSH data available.


Related in: MedlinePlus