title: [Autoimmune pancreatitis associated with rheumatoid arthritis: successful combination therapy with steroids and methotrexate].
abstract: MEDICAL HISTORY AND CLINICAL FINDINGS: A 70-year-old female patient suffered from steatorrhea and upper abdominal discomfort for 8 weeks combined with new onset of arthralgia in both hands. Additionally she reported elevated fasting blood glucose levels. The physical examination was without pathological findings except for mild upper abdominal pressure pain.
  
  
  METHODS
  Imaging studies, including MRI and ultrasound examinations showed diffuse pancreatic enlargement without peripancreatic vessel involvement. Serological examinations showed elevated Cancer Associated Antigen 19 - 9 (1289 U/ml) and hyperglobulinemia with an IgG level of 170 mg/dl. The inflammatory markers were within normal ranges other than a slightly elevated erythrocyte sedimentation rate (35mm/1 h). Subsequent pancreatic biopsy showed lymphoplasmocellular, neutrophile and eosinophile granulocyte infiltration causing damage of the acinar pancreatic cells, typical for autoimmune pancreatitis (AIP). Magnetic resonance imaging (MRI) confirmed arthritis of both hands.
  
  
  METHODS
  Medical treatment was started with oral prednisolone (50 mg/day) for one week, tapered to 25 mg/day for another 2 weeks, followed by dose reductions of 5 mg/day every 2 weeks with a final maintenance dose of 5 mg/day for 8 months. After the first week of steroid therapy methotrexate (MTX) was started with an initial dose of 10 mg/week. Dose was raised until a final dosage of 30 mg/week. After 8 months without relapse, the maintenance therapy was reduced to 20 mg/week MTX and corticosteroids were stopped.
  
  
  CONCLUSIONS
  With this treatment regimen the patient has showed complete remission of AIP and arthritis for 36 months. MTX may be successful as an initial basic treatment to reach better control of autoimmune-related extrapancreatic manifestations.
authors: Abteilung für Rheumatologie und Osteologie, Kaiser Franz Josef Spital Wien. monika.mustak@wienkv.at
authors: M
authors: M
authors: Mustak
authors: J
authors: J
authors: Boltuch-Sherif
authors: B
authors: B
authors: Horvath-Mechtler
authors: J
authors: J
authors: Kowalski-Bodzenta
authors: L
authors: L
authors: Erlacher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D001706:Biopsy; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008662:Metacarpophalangeal Joint / Q000473:pathology; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011239:Prednisolone; D008727:Methotrexate