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Monoarthritis revealing Infliximab-induced systemic lupus erythematosus in Crohn's disease


MOJ Orthopedics & Rheumatology
Salem Bouomrani,1,2 Fatma Rekik,1,2 Rim Mesfar,1,2 Ali Naffati,1,2 Warda Mahdhaoui,1,2 Amin Hammami,1,2 DhiaEddine Amri1,2

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Abstract

Introduction: Infliximab is increasingly used for the treatment of severe and resistant forms of Crohn's disease (CD). It is characterized by its efficiency and good tolerance. Induced systemic lupus erythematosus (SLE) remains an exceptional but potentially serious complication of this treatment and its diagnosis represents a real challenge for clinicians.

We are reporting an original observation of infliximab-induced SLE in CD whose revealing clinical presentation was an isolated monoarthritis.

Case report: A 28-year-old woman, followed for severe and resistant to first-line treatment CD since the age of 20. Treatment with infliximab was thus initiated with a satisfactory effect. During her admission for the fifth infusion of infliximab, she reported inflammatory arthralgia in the small joints of her hands. Somatic examination noted an isolated arthritis of the proximal interphalangeal joint of the right fifth finger. Biology noted leukopenia at 2000/mm3, neutropenia at 1250/mm3, lymphopenia at 634/mm3, and erythrocyte sedimentation rate at 68mm/H1. Anti-nuclear antibodies were positive at 1/640 and anti-double stranded DNA antibodies were positive at 1/160. Thus, the diagnosis of infliximab-induced SLE was retained. Infliximab was discontinued, and the outcome was favorable under systemic corticosteroid therapy associated with Hydroxychloroquine and Mesalazine.

Conclusion: As rare as it is, this complication of biotherapy deserves to be known by clinicians and the diagnosis deserves to be mentioned in front of any monoarthritis occurring in CD patient under anti-TNFα therapy.

Keywords

monoarthritis, infliximab, systemic lupus erythematosus, Crohn disease, drug-induced lupus, DNA antibodies, potentially serious, monoarthritis, systemic glucocorticoids, azathioprine, joint destruction, deformity, uric acid, anti-histone antibodies

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