title: DPP4 inhibitor-induced polyarthritis: a report of three cases.
abstract: Dipeptidyl peptidase-4 (DPP4) inhibitors are a novel therapy widespread used in type 2 diabetes mellitus. We describe 3 cases of polyarthritis which delay of appearance strongly suggests a link with DPP4 inhibitors. Three patients presented with bilateral, symmetrical, seronegative polyarthritis after introduction of DPP4 inhibitors (sitagliptine (n = 2) and vildagliptine (n = 1)). Two patients also developed xerostomia and xerostomia, and laboratory test results showed normal values of CRP and erythrocyte sedimentation rate. Joints X-rays were normal. One patient was diagnosed with primary Sjögren's syndrome and treated with hydroxychloroquine, methotrexate and prednisone, with a poor efficacy. When sitagliptine was stopped, all symptoms disappeared, leading to methotrexate and prednisone discontinuation within a month. There were no immunological abnormalities in the 2 other patients, but a chronic viral hepatitis B was found in one patient. Eventually, discontinuation of DPP4 inhibitors led to resolution of symptoms in 1 and 3 weeks for both patients. DPP4 inhibitors seemed to trigger bilateral, non-erosive, seronegative polyarthritis in our 3 patients. DPP4, also known as CD26, is expressed on many cells including lymphocytes and fibroblasts, and its inhibition may lead to immunomodulating effect as suggested by clinical and in vitro studies.
authors: Service de Médecine Interne, Hôpital Foch, Université Versailles-Saint Quentin en Yvelines, 40 rue Worth, 92150, Suresnes, France.
authors: Etienne
authors: E
authors: Crickx
authors: Ibrahim
authors: I
authors: Marroun
authors: Christine
authors: C
authors: Veyrie
authors: Christine
authors: C
authors: Le Beller
authors: Yoland
authors: Y
authors: Schoindre
authors: Florence
authors: F
authors: Bouilloud
authors: Olivier
authors: O
authors: Blétry
authors: Jean-Emmanuel
authors: JE
authors: Kahn
mesh_terms: D000218:Adamantane / Q000009:adverse effects / Q000031:analogs & derivatives; D001168:Arthritis / Q000139:chemically induced* / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology; D018819:Dipeptidyl Peptidase 4 / Q000378:metabolism*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009570:Nitriles / Q000009:adverse effects; D011719:Pyrazines / Q000009:adverse effects; D011759:Pyrrolidines / Q000009:adverse effects; D012307:Risk Factors; D000068900:Sitagliptin Phosphate; D014230:Triazoles / Q000009:adverse effects; D000077597:Vildagliptin
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D009570:Nitriles; D011719:Pyrazines; D011759:Pyrrolidines; D014230:Triazoles; C042807:DPP4 protein, human; D018819:Dipeptidyl Peptidase 4; D000077597:Vildagliptin; D000218:Adamantane; D000068900:Sitagliptin Phosphate