Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Vedolizumab (VDZ) is a monoclonal antibody approved for inflammatory bowel disease, with a gut-specific mechanism of action, binding to α4β7 integrine expressed on gut-homing T lymphocytes. Few cases of flare or new occurrence of rheumatic disorders in patients treated with VDZ were reported in literature (1-2). A small cohort study (3) did not report new induction or flare of arthritis and/or sacroiliitis and some patients with active SpA showed some improvement in symptoms after VDZ. Our purpose is to observe the possible role of VDZ in new onset/recurrence of rheumatic manifestations.
Observational study of a series of 7 patients with IBD who developed inflammatory arthralgia after treatment with VDZ.
Four out of 7 patients were women and 6 patients had been diagnosed with Crohn’s disease (CD), 1 with ulcerative colitis (UC). The mean duration of IBD was of 14 years. The mean age was 49.8 years (range 24-63). None of the patients had previous history of arthritis/spondyloarthritis. One patient who was previously treated with Infliximab and Mesalazine, during the course of the treatment suffered from an episode of arthritis with spontaneous remission, 9 years before starting VDZ. Six patients out of 7 had previously been treated with biologic therapy, in 2/6 patients VDZ was the 2nd-line biologic therapy and in 4/6 patients the 3rd-line. Six patients fulfilled the ASAS criteria for spondyloarthritis (4-5), 1 was classified as unspecified inflammatory arthralgia. The mean number of infusions of VDZ received before the onset of symptoms was 3 (range 1-6) and the mean time of exposure to VDZ was 11 weeks (range 1-32). Five patients had high levels of inflammation with mean CRP of 15.6 mg/L (range 0.6-42.2). Three patients with back pain performed a MRI that showed sacroiliitis. In 2 cases HLA-B27 was investigated with negative result. Four patients discontinued VDZ, 3 restarted the previous biologic therapy with Adalimumab and 1 was started on Infliximab.
This is the longest series collected so far regarding rheumatic manifestations developed after onset of VDZ treatment for IBD. Further studies are needed to investigate the role of VDZ in rheumatic diseases.
Varkas et al. Ann Rheum Dis 2017; 76:878–881
Wendling et al. Joint Bone Spine 2018; 85:255–256
Orlando et al. Ann Rheum Dis 2017; 76
Rudwaleit et al. Ann Rheum Dis 2011; 70:25-31
Rudwaleit et al. Ann Rheum Dis 2009; 68:777-783
To cite this abstract in AMA style:Tamanini S, Fredi M, Bazzani C, Lazzaroni MG, Fernandes M, Nalli C, Tincani A, Franceschini F. New Onset/Recurrence of Inflammatory Arthralgia/Spondyloarthritis in Patients Treated with Vedolizumab for Intestinal Bowel Disease [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/new-onset-recurrence-of-inflammatory-arthralgia-spondyloarthritis-in-patients-treated-with-vedolizumab-for-intestinal-bowel-disease/. Accessed November 12, 2019.
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