title: Tumor necrosis factor-alpha inhibitor associated ulcerative colitis.
abstract: BACKGROUND
  Flares or onset of inflammatory bowel disease in association with immunosuppression has been reported in the literature.
  
  
  METHODS
  We studied 4 cases of patients with rheumatic disease who developed or had a flare of ulcerative colitis either after initiation of or while taking a tumor necrosis factor-alpha inhibitor.
  
  
  RESULTS
  We identified 4 patients, three male and one female. Two of the male patients had a seronegative spondyloarthropathy and one had rheumatoid arthritis. The female patient had amyopathic dermatomyositis. Two of the 4 patients had ulcerative colitis prior to tumor necrosis factor-alpha treatment. Both of these patients had quiescent ulcerative colitis that flared after they began taking etanercept. Two patients developed de novo ulcerative colitis while taking a tumor necrosis factor-alpha inhibitor.
  
  
  CONCLUSIONS
  The data presented in these 4 cases supports a temporal relationship between initiating a tumor necrosis factor-alpha inhibitor and onset or flare of ulcerative colitis. These observations raise the possibility that tumor necrosis factor-alpha inhibitor therapy, which has been used as treatment for inflammatory bowel disease, may rarely be a factor in the development of disease.
authors.affiliation: Internal Medicine Department, Rheumatic Diseases Division, University of Texas Southwestern Medical Center, Dallas, Texas, USA. kprescott74@yahoo.com
authors.forename: Kara
authors.initials: K
authors.lastname: Prescott
authors.forename: Melissa
authors.initials: M
authors.lastname: Costner
authors.forename: Stanley
authors.initials: S
authors.lastname: Cohen
authors.forename: Salahuddin
authors.initials: S
authors.lastname: Kazi
mesh_terms: D000328:Adult; D000368:Aged; D003093:Colitis, Ulcerative / Q000139:chemically induced* / Q000150:complications; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept