Reumatizam, Vol. 68 No. 2, 2021.
Pregledni rad
https://doi.org/10.33004/reumatizam-68-2-4
Tuberculosis spondylodiscitis in a patient with psoriatic arthritis on targeted synthetic disease-modifying antirheumatic drugs – case report
Adelmo Šegota
Tea Schnurrer Luke Vrbanić
Danijela Veljković-Vujaklija
Viviana Avancini-Dobrović
Doris Stamenković
Sažetak
Tuberculosis (TB) has been recognised as an important opportunistic infection that occurs in patients with inflammatory rheumatic diseases. The results of global registries show that the risk of reactivation of latent TB or the development of new TB infection increases in patients treated with tumour necrosis factor inhibitors (TNFis). However, the results of randomised clinical studies and few data from everyday practice show that targeted synthetic disease- modifying anti-rheumatic drugs (tsDMARD s) such as apremilast and janus kinase inhibitors (JAK i), have a lower risk of TB activation compared to TNFis. In this article, we shall present a male patient in whose case skin psoriasis preceded the development of articular involvement, and the definite diagnosis of psoriatic arthritis (PsA). He was treated with conventional synthetic diseasemodifying anti-rheumatic drugs (csDMARD s) methotrexate and sulfasalazine, and, following that, with tsDMARD s apremilast and tofacitinib, with previously obtained negative results of hepatitis markers and QuantiFERON -TB Gold (QFT) test for latent tuberculosis. Considering the intense pain in the lumbosacral segment of the spine along with the occurrence of fever and alteration of serological inflammatory laboratory markers, the diagnostic evaluation was performed in order to determine the presence of TB spondylodiscitis L5-S1 with epidural abscess and abscess in the right psoas muscle. Specific therapy was discontinued, and, following that, surgical abscess drainage, and microdiscectomy and vertebrosynthesis of the L5-S1 lumbosacral joint were performed. In addition to that, the anti-TB therapy was induced for a total duration of 12 months. In conclusion, this is the first case report in literature which discusses the case of tuberculous spondylodiscitis in patients with PsA treated with tofacitinib. The patient had been treated with apremilast for 3 months a year earlier, but the connection between the use of the aforementioned drug and the development of extrapulmonary tuberculosis was not established. Results from national registries need to be collected due to the fact that phase III randomised controlled trials did not register any cases of TB in PsA patients treated with tofacitinib. In the event of symptoms that do not fit into the clinical features of PsA, the possibility of developing pulmonary or extrapulmonary TB manifestations
should be considered even though the patient is being treated with tsDMARD s.
Ključne riječi
apremilast, psoriatic arthritis, tofacitinib, tuberculosis
Hrčak ID:
287144
URI
Datum izdavanja:
4.12.2022.
Posjeta: 435 *