Yonsei Med J.  2008 Feb;49(1):159-162.

Successful Etanercept Therapy for Refractory Sacroiliitis in a Patient with Ankylosing Spondylitis and Mixed Connective Tissue Disease

• Lee JY
• Chang HK
• Kim SK

Abstract

The concurrence of ankylosing spondylitis (AS) in a patient with mixed connective tissue disease (MCTD) is rarely described in the literature. Significant and sustained efficacy with tumor necrosis factor (TNF)-alpha blockers has been demonstrated in AS patients. However, evidence to date has revealed associated side effects, including antinuclear antibody induction and development of a lupus-like syndrome. Several authors have reported lupus-like manifestations in MCTD patients treated with TNF-alpha blockers used to control peripheral polyarthritis. In our case report, we demonstrate a good response to etanercept therapy for refractory sacroiliitis in a patient with coexisting AS and MCTD, without development of a lupus-like syndrome. This demonstrates that etanercept therapy may be an appropriate therapeutic agent for sacroiliitis in MCTD patients, as it is in AS alone.

Keyword

Ankylosing spondylitis; mixed connective tissue disease; etanercept

MeSH Terms

Female
Humans
Immunoglobulin G/*therapeutic use
Magnetic Resonance Imaging
Middle Aged
Mixed Connective Tissue Disease/complications/*drug therapy/*pathology
Receptors, Tumor Necrosis Factor/*therapeutic use
Sacroiliac Joint/*drug effects/*pathology
Spondylitis, Ankylosing/complications/*drug therapy/*pathology
Treatment Outcome

Figure

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  Fig. 1 (A) Magnetic resonance coronal fat suppressed T2-weighted image (WI) of both sacroiliac joints showing increased signal intensity within the joint spaces and subchondral marrow edema. Also present are subchondral erosions and localized fat deposition in the subchondral marrow spaces. (B) After 18 months, significant improvement of joint spaces with high signal intensity on fat-suppressed T2-WI with subchondral marrow edema identified at the same level.

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