Infliximab in spondyloarthropathy associated with Crohn's disease: an open study on the efficacy of inducing and maintaining remission of musculoskeletal and gut manifestations

Abstract

Objective: To evaluate the efficacy and tolerability of anti-tumour necrosis factor a (TNFa) monoclonal antibody (infliximab) in the treatment of spondyloarthropathy (SpA) associated with active and inactive Crohn's disease (CD). Methods: Twenty four patients with SpA associated with active or inactive CD (16 active, 8 quiescent) were treated with anti-TNFa monoclonal antibody (infliximab) with repeated infusions for a period of 12-18 months. The treatment aimed at ameliorating the general musculoskeletal and spinal pain, controlling peripheral arthritis and enthesitis, decreasing the BASDAI score, modifying acute phase reactants, and reducing CD activity. Results: Infliximab improved both gastrointestinal (p,0.01) and overall articular symptoms (BASDAI, p,0.01; general musculoskeletal and spinal pain, p,0.01; peripheral arthritis, p,0.01) in patients with active CD. Additionally, infliximab effectively controlled not only axial involvement and peripheral arthritis but also enthesitis (p,0.01) and prevented inflammatory bowel disease reactivation in patients with inactive CD and low inflammatory markers. Amelioration of gut and musculoskeletal involvement persisted for up to 12 months. Conclusion: Infliximab may act on the inflammation of entheses and of periarticular structures, which usually does not cause a change in the haematological markers that are the main indicators of pain and joint ankylosis in SpA. Infliximab induces and maintains remission of CD while at the same time treating active and severe SpA, suggesting that it should be the preferred drug for the treatment of active and severe SpA associated with active or quiescent CD.

Adalimumab produces clinical remission and reduces extraintestinal manifestations in Crohnʼs disease: Results from CARE

“…4,[17][18][19][20] A small (N ¼ 30) randomized controlled trial comparing infliximab to placebo for the treatment of pyoderma gangrenosum found a higher rate of clinical improvement at week 2 in the infliximab recipients (46% versus 6%, P ¼ 0.025), 21 although not all of the patients in this series had inflammatory bowel disease. A recent publication of an observational analysis of adalimumab use for CD in a referral center 22 found a meaningful rate of complete resolution of EIMs at week 4 (31.5%) and week 12 (41%).…”

Extraintestinal Manifestations of Crohn’s Disease

“…In this paper, Generini et al[ 38] described good axial and peripheral musculoskeletal pain control with infliximab in addition to the gastrointestinal improvement in 15 patients with active CD. In AS alone, infliximab and etanercept have now been approved, based on large placebo-controlled studies, for patients insufficiently treated with sulfasalazine and NSAIDs or intolerant of NSAIDs [39,40,41].…”

Detection of Crohn Disease in Patients with Spondyloarthropathy: The SpACE Capsule Study

“…Our findings are thus in keeping with other studies 44,50 . Anti-TNF therapy has been shown to induce and maintain remission of CD, while at the same time treating severe active SpA 51 , suggesting that it should be the preferred drug for the treatment of active and severe SpA associated with active or quiescent CD. These results are likely to have an important effect on the selection of anti-TNF therapy in patients with SpA.…”