title: GLP-1 receptor agonist-induced polyarthritis: a case report.
abstract: Occasional cases of bilateral, symmetrical, seronegative polyarthritis have been reported in patients treated with dipeptidyl peptidase-4 inhibitors (Crickx et al. in Rheumatol Int, 2013). We report here a similar case observed during treatment with a GLP-1 receptor agonist. A 42-year-old man with type 2 diabetes treated with metformin 1,500 mg/day and liraglutide 1.8 mg/day. After 6 months from the beginning of treatment, the patient complained of bilateral arthralgia (hands, feet, ankles, knees, and hips). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and leukocytes were increased. Rheumatoid factor, anticyclic citrullinated protein antibody, antinuclear antibodies, anti-Borrelia, and burgdorferi antibodies were all negative, and myoglobin and calcitonin were normal. Liraglutide was withdrawn, and the symptoms completely disappeared within 1 week, with normalization of ESR, CRP, fibrinogen, and leukocytes. Previously described cases of polyarthritis associated with DPP4 inhibitors had been attributed to a direct effect of the drugs on inflammatory cells expressing the enzyme. The present case, occurred during treatment with a GLP-1 receptor agonists, suggests a possibly different mechanism, mediated by GLP-1 receptor stimulation, which deserved further investigation.
authors.affiliation: Geriatric Cardiology, Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, 50141, Florence, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Ambrosio
authors.forename: Matteo
authors.initials: M
authors.lastname: Monami
authors.forename: Lavinia
authors.initials: L
authors.lastname: Sati
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Mauro
authors.initials: M
authors.lastname: Di Bari
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
mesh_terms: D000328:Adult; D001168:Arthritis / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D052216:Glucagon-Like Peptide 1 / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000067757:Glucagon-Like Peptide-1 Receptor; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000069450:Liraglutide; D008297:Male; D018027:Receptors, Glucagon / Q000819:agonists*
chemical_list: C000593833:GLP1R protein, human; D000067757:Glucagon-Like Peptide-1 Receptor; D007004:Hypoglycemic Agents; D018027:Receptors, Glucagon; D000069450:Liraglutide; D052216:Glucagon-Like Peptide 1