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. 2004 Aug 5;63(12):1664–1669. doi: 10.1136/ard.2003.012450

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

S Generini 1, R Giacomelli 1, R Fedi 1, A Fulminis 1, A Pignone 1, G Frieri 1, A Del Rosso 1, A Viscido 1, B Galletti 1, M Fazzi 1, F Tonelli 1, M Matucci-Cerinic 1
PMCID: PMC1754868  PMID: 15297279

Abstract

Objective: To evaluate the efficacy and tolerability of anti-tumour necrosis factor α (TNFα) 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-TNFα 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.

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Figure 1.

Figure 1

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 Therapeutic flow chart for the treatment of active SpA associated with active or inactive CD.

Figure 2.

Figure 2

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 (A, B, C) Clinical and laboratory data (mean) of the patients with SpA and CD at baseline and during treatment with infliximab or various other conventional treatments (baseline, 45 days, 3, 6, 12, 18 months). The values of CDAI are split into two additional groups: patients with active or inactive CD at baseline.

Figure 3.

Figure 3

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 Percentage of patients presenting peripheral arthritis (A) or active enthesitis (B) at baseline and during the treatment (45 days, 3, 6, 12, 18 months) with infliximab or various other drugs (azathioprine, mesalazine, steroids, metronidazole, antibiotics). *The data reported at 12 months are relative to patients (10/21) who prolonged the treatment with infliximab for up to 12 months; no controls are available for this group.

Figure 4.

Figure 4

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 (A) Thickening and homogeneous hypoechogenicity of the Achilles tendon enthesis with distension of the retrocalcaneal bursa (arrows) which disappeared after 45 days of treatment with infliximab (B).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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