Etanercept in the treatment of recalcitrant enteropathic arthritis: A case report

Mohd Shahrir Mohamed Said, Syahrul Sazliyana Shaharir, Sakthiswary Rajalingham, Sheikh Anwar Abdullah, Aizan Bin Hassanudin, Ngiu Chai Soon, Mohd Shahdan Shahid

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Abstract

Introduction. Enteropathic arthritis is one of the recognized extraintestinal manifestations of inflammatory bowel disease and affects up to 25% of patients. The treatment options for refractory disease were rather limited and ineffective until the arrival of biologic therapy in the last few years. The use of etanercept was unique for this disease. Case presentation. In this case report, a 58-year-old Malay woman with a 17-year history of ulcerative colitis had persistent left knee effusion and synovitis for seven years, despite remission of the primary disease. She had had multiple courses of systemic and intra-articular steroid that caused significant systemic side effects such as impaired fasting glucose, hypertension, cataract, and weight gain. She also had a total left knee replacement for secondary osteoarthritis. But the left knee synovitis and effusion recurred a month after the total knee replacement, and she was subjected to a total synovectomy the following year. In view of failure of remission despite multiple immunosuppressants (100 mg of azathioprine daily, 1 g of sulfasalazine twice a day, 10 mg of prednisolone daily, and 10 mg of methotrexate weekly), 25 mg of subcutaneous etanercept twice weekly was started. After 5 weeks of treatment, complete resolution of left knee effusion and normalization of the inflammatory markers were shown. This continued up to 12 months of follow-up while our patient was on etanercept and 10 mg of methotrexate weekly. No relapse or serious side effects were noted. Conclusions: This case demonstrates the efficacy of etanercept in recalcitrant enteropathic arthritis with no relapse of the underlying colitis while on treatment. The usage of this tumor necrosis factor inhibitor was unique in this case of rheumatology and gastroenterology.

Original languageEnglish
Article number10
JournalJournal of Medical Case Reports
Volume6
DOIs
Publication statusPublished - 2012

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Arthritis
Knee
Knee Replacement Arthroplasties
Synovitis
Methotrexate
Recurrence
Sulfasalazine
Biological Therapy
Azathioprine
Rheumatology
Gastroenterology
Colitis
Therapeutics
Immunosuppressive Agents
Prednisolone
Ulcerative Colitis
Inflammatory Bowel Diseases
Osteoarthritis
Cataract
Weight Gain

ASJC Scopus subject areas

  • Medicine(all)

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Etanercept in the treatment of recalcitrant enteropathic arthritis : A case report. / Mohamed Said, Mohd Shahrir; Shaharir, Syahrul Sazliyana; Rajalingham, Sakthiswary; Abdullah, Sheikh Anwar; Bin Hassanudin, Aizan; Chai Soon, Ngiu; Shahid, Mohd Shahdan.

In: Journal of Medical Case Reports, Vol. 6, 10, 2012.

Research output: Contribution to journalArticle

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