Dramatic response after an intravenous loading dose of azathioprine in one case of severe and refractory ankylosing spondylitis.
We describe a 37-yr-old Caucasian male suffering from ankylosing spondylitis (AS) with long-standing severe inflammatory lumbar pain and hip arthritis who was refractory to non-steroidal anti-inflammatory drugs, sulphasalazine and methotrexate up to 25 mg/week. In this patient, administration of an i.v. loading dose of azathioprine (AZA; 40 mg/kg for 36 h followed by 2 mg/kg oral AZA therapy) induced a dramatic response in his clinical condition. Indeed, objective and subjective clinical variables improved within 1 week and were corroborated by a decline in the levels of the inflammatory parameters; anaemia was reported at month 3 but was rapidly reversible. If confirmed, an i.v. loading dose of AZA could represent a valuable alternative in severe and refractory AS, but toxicity of this regimen should be carefully analysed.
Durez
P
P
Department of Rheumatology, Hôpital Erasme, Université Libre de Bruxelles, 808 route de Lennik, B-1070 Brussels and. Department of Gastroenterology, Louvain Medical School, Louvain, Belgium.
Horsmans
Y
Y
D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001379:Azathioprine / Q000008:administration & dosage*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010147:Pain Measurement / Q000187:drug effects; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000097:blood / Q000188:drug therapy*; D013866:Thioguanine / Q000097:blood; D016896:Treatment Outcome
D018501:Antirheumatic Agents; D002097:C-Reactive Protein; D013866:Thioguanine; D001379:Azathioprine