title: TNF-alpha antagonist induced lupus on three different agents.
abstract: Tumor necrosis factor alpha (TNF alpha) antagonists are biologic agents used in the management of inflammatory conditions such as rheumatoid arthritis, seronegative spondyloarthropathies and inflammatory bowel disease. These agents have been recently shown to cause a syndrome called anti-TNF induced lupus (ATIL), a rare condition which has similar clinical manifestations to idiopathic systemic lupus erythematosus (SLE). Given that extra-intestinal manifestations of inflammatory bowel disease include arthritis, it can be difficult to separate arthritis due to underlying disease from drug-induced arthritis. We present a case of a 28-year-old female with Crohn's disease, who developed disabling arthritis as a clinical manifestation of ATIL following treatment with three anti-TNF agents, namely infliximab, adalimumab and certolizumab.
authors.affiliation: a Department of Internal Medicine , Staten Island University Hospital , Staten Island , NY , USA.
authors.forename: Bindu Madhavi
authors.initials: BM
authors.lastname: Mudduluru
authors.affiliation: b Department of Internal Medicine , Lenox hill Hospital , New York , NY , USA.
authors.forename: Shalin
authors.initials: S
authors.lastname: Shah
authors.affiliation: c Department of Gastroenterology , Lenox hill Hospital , New York , NY , USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Shamah
authors.affiliation: c Department of Gastroenterology , Lenox hill Hospital , New York , NY , USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Swaminath
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068582:Certolizumab Pegol / Q000009:adverse effects; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000009:adverse effects; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068582:Certolizumab Pegol
keywords: Anti-TNF induced lupus (ATIL); Crohns disease; Tumor Necrosis Factor alpha (TNF alpha) antagonists; adalimumab; certolizumab; infliximab