title: An induction or flare of arthritis and/or sacroiliitis by vedolizumab in inflammatory bowel disease: a case series.
abstract: BACKGROUND
  In inflammatory bowel disease (IBD), a new biological therapy has recently been approved. Vedolizumab is a humanised IgG1 monoclonal antibody to α4β7 integrin that modulates gut lymphocyte trafficking. Although an exclusively local effect of vedolizumab could be expected based on the restricted presence of the α4β7-mucosal vascular addressin cell adhesion molecule 1 complex in the gut, past combined success with anti-tumour necrosis factor, and previous demonstration of α4β7 integrin in the joint, led to the expectation of a therapeutic efficacy in spondyloarthritis. Nonetheless, the effect of vedolizumab on extraintestinal manifestations-and especially the joint-has not been reported so far.
  
  
  METHODS
  A series of five patients with IBD who were treated with vedolizumab and promptly developed new onset or exacerbation of sacroiliitis or arthritis are reported.
  
  
  CONCLUSIONS
  Vedolizumab therapy does not seem to show any efficacy in and might even induce arthritis and/or sacroiliitis. However, larger cohort studies are needed to provide information on the prevalence, the evolution and underlying mechanism.
authors.affiliation: Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.|VIB Inflammation Research Center, Ghent University, Ghent, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Varkas
authors.affiliation: Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.|Department of Rheumatology/Physical medicine and rehabilitation, AZ Alma, Sijsele-Eeklo, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Thevissen
authors.affiliation: Department of Rheumatology, AZ Sint-Lucas Brugge, Bruges, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: De Brabanter
authors.affiliation: Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Van Praet
authors.affiliation: The Crohn's and Colitis Center, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: F
authors.initials: F
authors.lastname: Czul-Gurdian
authors.affiliation: Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.|VIB Inflammation Research Center, Ghent University, Ghent, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Cypers
authors.affiliation: Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: De Kock
authors.affiliation: Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.|Department of Rheumatology/Physical medicine and rehabilitation, AZ Alma, Sijsele-Eeklo, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Carron
authors.affiliation: Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: De Vos
authors.affiliation: Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Hindryckx
authors.affiliation: Department of Gastroenterology, AZ Sint-Lucas Brugge, Bruges, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Arts
authors.affiliation: Department of Rheumatology/Physical medicine and rehabilitation, AZ Alma, Sijsele-Eeklo, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Vanneuville
authors.affiliation: Department of Gastroenterology, AZ Alma, Sijsele-Eeklo, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Schoenaers
authors.affiliation: Department of Gastroenterology, AZ Alma, Sijsele-Eeklo, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Claerhout
authors.affiliation: The Crohn's and Colitis Center, Miller School of Medicine, University of Miami, Miami, Florida, USA.
authors.forename: M
authors.initials: M
authors.lastname: Abreu
authors.affiliation: Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Van den Bosch
authors.affiliation: Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.|VIB Inflammation Research Center, Ghent University, Ghent, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Elewaut
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000188:drug therapy; D003424:Crohn Disease / Q000188:drug therapy; D005260:Female; D005765:Gastrointestinal Agents / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058566:Sacroiliitis / Q000139:chemically induced*; D013167:Spondylitis, Ankylosing / Q000139:chemically induced*; D000067251:Symptom Flare Up
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; C543529:vedolizumab
keywords: Arthritis; Inflammation; Magnetic Resonance Imaging; Spondyloarthritis; Treatment