Etanercept-induced Crohn’s disease in ankylosing spondylitis: a case report and review of the literature

TOLU S., REZVANİ A., Hindioglu N., Calkin Korkmaz M.

Rheumatology International, vol.38, no.11, pp.2157-2162, 2018 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 38 Issue: 11
  • Publication Date: 2018
  • Doi Number: 10.1007/s00296-018-4165-3
  • Journal Name: Rheumatology International
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.2157-2162
  • Keywords: Ankylosing spondylitis, Crohn's disease, Tumor necrosis factor-alpha inhibitors, Etanercept, Mechanism of action
  • Istanbul Medipol University Affiliated: Yes

Abstract

Tumor necrosis factor (TNF)-α is a cytokine that plays a well-established, key role as a central mediator of inflammation and immune regulation. TNF-α and its receptors are suggested to play a critical role in a number of chronic inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (AS), juvenile chronic arthritis, and inflammatory bowel disease (IBD). TNF-α inhibitors are currently used in the treatment of these diseases. We report a 29-year-old male with AS who developed Crohn’s disease while taking etanercept. Etanercept treatment was interrupted and a switch to a monoclonal antibody-based anti-TNF treatment using adalimumab was started, which induced a prompt improvement of the gastrointestinal symptoms. We indicate the immunodysregulatory and proinflammatory effects of etanercept and discuss the potential pathogenic mechanisms of the paradoxical effect of TNF-α inhibitors. We also review the related literature on new-onset IBD following anti-TNF treatment for AS.