SPONDYLARTHROPATHY
IN ADULT CYSTIC FIBROSIS: INTEREST OF INFLIXIMAB
M Laurans, C Marcelli,
JY Guincestre, JF Duhamel
Department of Pediatrics
and Rheumatology, CAEN University, France
Patients
with cystic fibrosis have demonstrated more arthritis with their longer
life expectancy. The most common presentations have been that of an
episodic arthritis (EA) or a hyperthrophic osteoarthropathy (HPOA).
However, other arthropathies which could not be classified as EA or HPOA,
have been associated with CF. We have reported the case of 21-years-old
woman with cystic fibrosis (deltaF508- R851X ) chronically colonized with
Pseudomonas aeruginosa. She had an active ankylosing spondylitis (AS)
characterised by repeated mechanical back and buttock pain (pain > 50mm
on visual analog scale), clinical and radiological sacroileitis, HLA B27
positive, with elevated CRP levels (60mg/l) and erythrocyte sedimentation
rate (100mm) without peripheral synovitis and uveitis. The symptomatic
treatment by nonsteroidalantiinflammatory ( NSAID) drugs was inefficient.
She was treated after multidisciplinary decision with infliximab (5 mg/kg)
at weeks 0, 2 and 6. There was a significant improvement in all clinical,
radiological and laboratory variables assessed within 5 weeks. But nausea,
allergic reactions were the main reported adverse events. AS occurs after
infection or vaccination. The cause is unclear, but may relate to chronic
infection and immune complex mechanisms. We confirm association of CF with
an AS, after Dixey (patient HLA B27-). Preliminary data from uncontrolled
studies support the efficacy of infliximab for NSAID refractory AS but with
a short-term though remnant effect, leading to iterative injections, and
warrant further evaluation in controlled trials.