Extraarticular manifestations of rheumatic diseases and the possibilities of their alleviation by biological therapy
Authors:
Š. Forejtová
Authors‘ workplace:
Revmatologický ústav Praha a Revmatologická klinika 1. LF UK, Praha
Published in:
Čes. Revmatol., 19, 2011, No. 2, p. 80-85.
Category:
Posts from Congress
Overview
Rheumatoid arthritis and ankylosing spondylitis are chronic inflammatory rheumatic diseases manifesting mainly by pain of joints and spine. Extraarticular manifestations such as involvement of entheses, skin, gut, eye, and others can be an important part of the disease. Systemic manifestations such as amyloidosis, vasculitis, more frequent occurrence of osteoporosis and accelerated development of atherosclerosis can occur simultaneously with the extraarticular manifestations. It was found that anti-TNFα therapy successfully affects the incidence of enthesitis, skin manifestations, uveitis and intestinal involvement in patients with ankylosing spondylitis, in both fully expressed and subclinical form of idiopathic inflammatory bowel disease. Patients treated with anti-TNFα antibodies were shown to have decreased incidence of uveitis compared to patients treated with etanercept. Treatment with infliximab or adalimumab is also indicated in patients with spondylarthritis with concomitant intestinal involvement. Anti-TNFα therapy in rheumatoid arthritis and ankylosing spondylitis has a beneficial effect on the increase of bone density compared to placebo treated individuals. The results from some studies and national registries imply that this therapy could reduce the incidence of cardiovascular events in comparison with untreated individuals. However, biological therapy may paradoxically cause development of autoimmune diseases, namely both organ specific and systemic diseases.
Key words:
biological therapy, anti-TNFα therapy, extraarticular manifestations, autoimmune diseases, atherosclerosis, osteoporosis
Sources
1. Brophy S, Pavy S, Lewis P, et al. Inflammatory eye, skin, and bowel disease in spondylartropatis: genetic, phenotypic, and enviromental factors. J Rheumatol 2001; 28: 2667-2673.
2. de Vlam K, Mielants H, Cuvelier C, et al. Spondylartropathy is underestimated in inflammatory bowel disease: prevalence and HLA assotiation. J Rheumatology 2000: 27: 2860-2865.
3. Leirisalo-Repo M, Turunen U, Stenman S, et al. High frequency of silent inflammatory bowel disease in spondylartropathy. Arthritis Rheum 1994; 37:23-31.
4. Mielants H, Veys EM, De Vos M, et al. The evaluation of spondylartropaties in relation tu gut histology. I: Clinical aspects. J Rheumatol 1995: 22: 2266-2272.
5. Mielants H, Veys EM, De Vos M, et al. The evaluation of spondylartropaties in relation tu gut histology. II: Histological aspects. J Rheumatol 1995:22:2273-2278.
6. Mielants H, Veys EM, De Vos M, et al. The evaluation of spondylartropaties in relation tu gut histology. III: Relation between gut and joint. J Rheumatol 1995: 22: 2279-2284.
7. Boonen A, van der Linden SM. The burden of ankylosing spondylitis. J Rheumatol (Suppl.) 2006;78: 4-11.
8. Zeboulon N, Dougados M, Gossec L. Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Ann Rheum Dis. 2008;67:955-959.
9. Jaakkola E, Herzberg I, Laiho K, et al. Finnish HLA studies confirm the increased risk conferred by HLA-B27 homozygosity in ankylosing spondylitis. Ann Rheum Dis 2006; 65: 775-780.
10. Chen CH, Lim KC, Chen HA, et al. Assotiation of acute anterior uveitis with disease activity, functional ability a physical mobility in patients with ankylosing spondylitis: a cross-sectional study of Chines patients in Taiwan. Clin Rheumatol 2007;26:953-957.
11. Rothova A, Buitenhuis HJ, Christiaans BJ, et al. Acute anterior uveitis (AAU) and HLA-B27. Br J Rheumatol 1983; 22: 144-145.
12. Baert FJ, DęHaens GR, Peeters M, et al. Tumour necrosis factor α antibody (infliximab) therapy profoundly down-regulates the inflammation in Crohnęs ileocolitis. Gastroenterology 1999; 116: 22-28.
13. Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohnęs disease: the ACCENT I randomised trial. Lancet 2002; 359: 1541-1549.
14. Rutgeerts P, Sandborn WJ, Feagan BG, et al.Infliximab for induction and maintenance therapy for ulcerative colitis.N Engl J Med 2005 8;353(23): 2462-76. Erratum in: N Engl J Med 2006 May 18; 354(20): 2200.
15. Hanauer SB, Sandborn WJ, Rutgeerts P, Fedorak RN, Lukas M, MacIntosh D, Panaccione R, Wolf D, Pollack P Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial Gastroenterology 2006 Feb;130(2): 323-333.
16. Afif W, Leighton JA, Hanauer SB, et al. Open-label study of adalimumab in patients with ulcerative colitis including those with prior loss of response or intolerance to infliximab. Inflamm Bowel Dis 2009; 15(9): 1302-7.
17. Wiegering V, Morbach H, Dick A, Girschick HJ. Crohn’s disease during etanercept therapy in juvenile idiopathic arthritis: a case report and review of the literature. Rheumatol Int 2010; 30(6): 801-804.
18. Haraoui B, Krelenbaum M.Emergence of Crohn’s Disease During Treatment with the Anti-Tumor Necrosis Factor Agent Etanercept for Ankylosing Spondylitis: Possible Mechanisms of Action.Semin Arthritis Rheum 2009; 39(3): 176-181.
19. Braun J, Baraliakos X, Listing J, et al. Differences in the incidence of flares or new onset of inflammatory bowel disease in patients with ankylosing spondylitis exposed to therapy with antitumour necrosis factor alpha agents. Arthritis Rheum 2007; 57: 639-647.
20. Braun J, Baralioakos X, Listing J, Sieper J. Decreased incidence of anterior uveitis in patients with ankylosing spondylitis treated with anti-tumor necrosis factor agents infliximab and etanercept. Arthritis Rheum 2005; 52: 2447-2451.
21. Smith JR, Levinson RD, Holland GN, et al. Differential efficacy of tumor necrosis factor inhibition in the management of inflammatory eye disease and associated rheumatis disease. Arthritis Rheum 2001; 45: 252-257.
22. Reiff A, Takei S, Sadeghi S et al. Etanercept therapy in childern with treatment-resistent uveitis. Arthritis Rheum 2001; 44: 1411-1415.
23. Tynjälä P, Lindahl P, Honkanen V. et al. Infliximab and etanercept in the treatment of chronic uveitis associated with refractory juvenile idiopathic arthritis. Ann Rheum Dis 2007; 66: 548-550.
24. Lim LL, Fraunfelder FW, Rosenbaum JT. Do tumor factor inhibitors cause uveitis? Arthritis Rheum 2007; 56: 3248-3252.
25. Wang F, Wang N.-S. Etanercept therapy associated acute uveitis: a case report and literature review. Clin Exp Rheumatol 2009; 27:838-839.
26. Rudwaleit M, RŅdevand E, Holck P, et al. Adalimumab effectively reduces the rate of anterior uveitis flares in patients with aktive ankylosing spondylitis: results of a prospective open-label trial. Ann Rheum Dis 2009; 68: 696-701.
27. Tynjälä P, Kontaniemi K, Lindahl P, et al. Adalimumab in juvenilie idiopathic artjritis – associated chronic anterior uveitid. Rheumatology 2008; 47: 339-344.
28. Lee RW, Dick AD. Treat early and embrace the evidence in favour of anti-TNF-alpha therapy for Behćet’s uveitis. Br J Ophthalmol 2010; 94: 269-70.
29. Braun J, Brandt J, Listing J, et al. Treatment of active ankylosing spondylitis with infliximab: a randomised controlled multicentre trial. Lancet 2002; 359(9313): 1187-93.
30. Dougados M, Combe B, Braun J, et al. A randomised, multicentre, double-blind, placebo- controlled trial of etanercept in adults with refractory heel entezitis in spondylarthritis: the HEEL trial. Ann Rheum Dis 2010; 69: 1430-35.
31. Toussirot E, Wnding D. Bone mass in ankylosing spondylitis. Clin Exp Rheumatol 2000;18 Suppl 21: S16-S20.
32. Gratacos J, Collado A, Pons F, et al. Significant loss of bone mass in patients with early, active ankylosing spondylitis: a follow up study. Arthritis Rheum 1999; 42: 2319-2324.
33. El Maghraoui A. Osteoporosis and ankylosing spondylitis. Joint Bone Spine 2004; 71: 291-295.
34. Cooper C, Carbone L, Michet C, Atkinson E, OęFallon W, Melton L. Fracture risk in patients with ankylosing spondylitis – a population based study. J Rheumatol 1994;53:117-121.
35. Donnelly S, Doyle DV, Denton A, Rolfe I, Mc Closkey EV, Spector TD. Bone mineral density and vertebral compresiion fracture rates in ankylosing spondylitis. Ann Arheum Dis 1994; 53: 117-121.
36. Allali F, Breban M, Porcher R, Maillefert JF, Dougados M, Roux C. Increase in bone mineral density of patients with spondyloarthropathy treated with anti-tumour necrosis factor alpha. Ann Rheum Dis 2003; 62: 347-9.
37. Visvanathan S, van der Heijde D, Deodhar A, Wagner C, Baker DG, Han J, Braun J. Effects of infliximab on markers of inflammation and bone turnover and associations with bone mineral density in patients with ankylosing spondylitis. Ann Rheum Dis 2009; 68: 175-82.
38. Gengenbacher M, Sebald HJ, Villiger PM, Hofstetter W, Seitz M. Infliximab inhibits bone resorption by circulating osteoclast precursor cells in patients with rheumatoid arthritis and ankylosing spondylitis. Ann Rheum Dis 2008; 67: 620-4.
39. Goodson NJ, Wales NJ, Lunt M et al. Mortality in early inflammatory polyartritis: cardiovascular mortality is increased in seropositive patients. Arthritis Rheum 2002; 46: 2010-2019.
40. Goodson NJ, Symmond DP, Scoty DG et al. Baseline levels of C-reactive protein and prediction of death from cardiovascular disease in patients with inflammatory polyartritis: a ten-year follow up study of primary care-based inception cohort. Arthritis Rheum 2005; 52: 2293-2299.
41. Maradit-Kremers H, Crowson CS, Nicola PJ, et al. Unrecognized coronary hearth disease and sudden deaths inn rheumatoid arthritis : a population based cohort study. Arthritis Rheum 2005; 52: 402-11.
42. Zochling J, Braun J. Mortality in ankylosing spondylitis. Clin Exp Rheumatol 2008; 26(Suppl. 51) S80-S84.
43. Lehtinen K. Mortality and causes of death in 398 patients admitted to hospital with ankylosing spondylitis. Ann Rheum Dis 1993; 52: 174-176.
44. Sarzi-Puttini P, Arzeni F, Doria A, et al. Tumour necrosis factor-alpha, biologic agents and cardiovascular risk. Lupus 2005;14:780-4.
45. Szekanecz Z, Kerekes D, Soltész P. Vascular effects of biologic agents in RA and spondylartropaties. Nat Rev Rheumatol 2009; 5: 677-684.
46. Jacobsson LT, Turesson G, Gulfe A, et al. Tratment with tumor necrosis factor blockers is associated with lower incidence of first cardiovascular events in patients with rheumatoid arthritis. J Rheumatol 2005; 32: 1213-8.
47. Dixon WG, Watson KD, Lunt M, Hyrich KL; British Society for Rheumatology Biologics Register Control Centre Consortium, Silman AJ, Symmons DP; British Society for Rheumatology Biologics Register. Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti-tumor necrosis factor alpha therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum 2007; 56(9): 2905-12.
48. Ramos-Casals M, Brito-Zerón P, Soto MJ, Cuadrado MJ, Khamashta MA. Autoimmune diseases induced by TNF-targeted therapies. Best Practise &Research Clinical Rheumatology 2008; 22: 847-861.
49. Ramos- Casals N, Roberto-Perez-Alverez, Diaz-Lageres C et al. Autoimmune diseases induced by biologia agents A double-edged sword? Autoimmunity Reviews 2010; 9: 188-193.
Labels
Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
2011 Issue 2
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