Etanercept-induced Crohn’s disease in ankylosing spondylitis: a case report and review of the literature
Tumor necrosis factor (TNF)-α is a cytokine that plays a well-established, key role as a central mediator of inflammation and immune regulation. TNF-α and its receptors are suggested to play a critical role in a number of chronic inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (AS), juvenile chronic arthritis, and inflammatory bowel disease (IBD). TNF-α inhibitors are currently used in the treatment of these diseases. We report a 29-year-old male with AS who developed Crohn’s disease while taking etanercept. Etanercept treatment was interrupted and a switch to a monoclonal antibody-based anti-TNF treatment using adalimumab was started, which induced a prompt improvement of the gastrointestinal symptoms. We indicate the immunodysregulatory and proinflammatory effects of etanercept and discuss the potential pathogenic mechanisms of the paradoxical effect of TNF-α inhibitors. We also review the related literature on new-onset IBD following anti-TNF treatment for AS.
KeywordsAnkylosing spondylitis Crohn’s disease Tumor necrosis factor-alpha inhibitors Etanercept Mechanism of action
The case was diagnosed and followed up by AR. ST conceived and planned the presented case report. ST wrote the manuscript with support from AR. Literature data were provided by ST, AR, NH, and MCK.
The authors declared that this study has received no financial support.
Compliance with ethical standards
Conflict of interest
No conflict of interest was declared by the authors. All authors had no relationships to any pharma agencies within the past 36 months.
The patient consented to publication of his case.
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