IgA Nephropathy—Ankylosing Spondylitis–Associated or Adalimumab-Induced?

Abstract

BACKGROUNDAnkylosing spondylitis (AS) is an immunemediated inflammatory disease that primarily affects the axial joints (spine and sacroiliac), but also the peripheral joints and entheses. In addition to inflammatory pain from osteoarticular involvement, a wide variety of extra-articular manifestations can occur, making AS a chronic multisystemic disorder. 1 The most commonly reported extra-articular manifestations are uveitis, psoriasis, inflammatory bowel disease, and cardiovascular disease; less common manifestations are renal, lung, or neurological involvement. 1 These symptoms are related to uncontrolled systemic inflammation and have important implications for clinical practice, so accurate diagnosis with early treatment is paramount.Treatment options for AS are physical exercise in association with nonsteroidal anti-inflammatory drugs (NSAIDs), followed by IL17-blockers or tumor necrosis factor inhibitors (TNFi), in cases with insufficient clinical response. 2 Both immunosuppressive agents have good efficacy; however, there is a higher number of patients treated with TNFi and consequently more experience in its use. 3 Adalimumab is a fully humanized monoclonal antibody that inhibits tumor necrosis factor-alpha signalling protein. 4 It is approved for management of several chronic inflammatory diseases and is one of the TNFi most widely choose in refractory AS because of its high efficiency and good tolerance and safety profile. 2

Double Glomerulonephritis in a Patient with Ankylosing Spondylitis Treated with Biologic Agent: Extrarticolar Involvement or Anti-Tumor Necrosis Factor Alpha Injury? A Case-Based Review

“…The association between IgA nephropathy and AS is known, 10,11 although not frequent: in a recent study by Lee and coworkers, 2 cases of IgA nephropathy at renal biopsy were detected among 681 patients (0.3%) in a context of about 8% of renal involvement. In the same series of patients no cases of Membranous nephropathy were highlighted.…”