Rheumatoid arthritis associated with primary biliary cholangitis under treatment with biological drugs
Report of 4 cases and update
Abstract
The therapeutic approach of patients with two or more autoimmune diseases is quite a challenge, especially when the treatment of one of them, can precipitate the progression of the other. Even though the association of rheumatoid arthritis (RA) and primary biliary cholangitis (PBC) is rare; when both coexist, the use of methotrexate and other hepatotoxic drugs should be used with caution. With a most widespread indication of biologic disease- modifying antirheumatic drugs (bDMARDs) some reports of patients with RA and PBC treated with etanercept, infliximab, rituximab, tocilizumab and abatacept have been published. We report a case series that includes 4 patients with RA and PBC treated with bDMARDs. This is the first report to describe two cases in which golimumab was used to control RA and the second to report patients who received adalimumab and abatacept. Three cases of patients treated with rituximab have been published to date. None of the patients of our report suffered a progression of their PBC; matter in fact, two of them showed an improvement in their biochemical parameters. PBC symptoms did not get worse in any of the patients. On the contrary, laboratory parameters improved in two of the four patients.References
I. Selmi C, Generali E, Cantarini L. Tumor necrosis Factor-Alpha at the Crossroad between Rheumatoid Arthritis and Autoinmune Cholangitis. IMAJ. 2015;17:112-113. Recuperado de:
https://www.ima.org.il/FilesUpload/IMAJ/0/107/53803.pdf
II. Caramella C, Avouac J, Sogni P, Puéchal X, Kahan A, Allanore Y. Association between rheumatoid arthritis and primary biliary cirrhosis. Joint Bone Spine. 2007;74:279-281. Recuperado de:
https://www.sciencedirect.com/science/article/pii/S1297319X07000784?via%3Dihub
III. Bittencourt PL, Cançado EL, Couto CA, Levy C, Porta G, Silva AE, et al. Brazilian society of hepatology recommendations for the diagnosis and management of autoimmune diseases of the liver. Arq Gastroenterol. 2015 Dec; 52 Suppl 1:15-46. Recuperado de:
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28032015000500015&lng=en&nrm=iso&tlng=en
IV. Spadaro A, Scrivo R, Riccieri V, Valesini G. Effect of tumor necrosis factor alpha antagonists in a patient with rheumatoid arthritis and primary biliary cirrhosis. Joint Bone Spine. 2008;75:87-9. Recuperado de: https://www.sciencedirect.com/science/article/pii/S1297319X07002473?via%3Dihub
V. Ogata A, Terabe F, Nakanishi K, Kawai M, Kuwahara Y, Hirano T, et al. Etanercept improved primary biliary cirrhosis associated with rheumatoid arthritis. Joint Bone Spine. 2009;76:105-7. Recuperado de:
http://www.sciencedirect.com/science/article/pii/S1297319X08002108
VI. Kubo S, Iwata S, Saito K, Tanaka Y. Successful treatment of primary biliary cirrhosis with etanercept in a patient with rheumatoid arthritis. Joint Bone Spine. 2011;78:535-6. Recuperado de:
https://www.sciencedirect.com/science/article/pii/S1297319X11001175?via%3Dihub
VII. Polido-Pereyra J, Rodrigues AM, Canhao H, Saraiva F, Pereira Da Silva JA, Fonseca JE. Primary Biliary cirrhosis in a rheumatoid arthritis patient treated with rituximab, a case-based review. Clin Rheumatol. 2012;31:385-9. Recuperado de: https://link.springer.com/article/10.1007%2Fs10067-011-1879-y
VIII. Lazrak F, Abourazzak FE, Berrada K, Kadi N, Manssouri S, Harzy T. A rare association of rheumatoid arthritis and primary biliary cirrhosis treated with rituximab: a case report. J Med Case Rep. 2013;7:99. Recuperado de: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668294/
IX. Saito E, Sato S, Nogi S, Sasaki N, Chichen N, Honda K, et al. A Case of Rheumatoid Arthritis and Limited Systemic Sclerosis Overlap Successfully Treated with Tocilizumab for Arthritis and Concomitant Generalized Lymphadenopathy and Primary Biliary Cirrhosis. Case Reports in Rheumatology. 2014; 2014:386328.http://dx.doi.org/10.1155/2014/386328. Recuperado de:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009268/
X. Kovács A, Siminischi AG, Baksay B, Gáll A, Takács M, Szekanecz Z. Successful Etanercept Treatment for Primary Biliary Cirrhosis Associated with Rheumatoid Arthritis. Isr Med Assoc J. 2015 Feb;17(2):114-6. Recuperado de:
https://www.ima.org.il/FilesUpload/IMAJ/0/107/53804.pdf
XI. D imopoulou D, Dimitroulas T, Akriviadis E, Garyfallos A. Infliximab as a treatment option for patients with rheumatoid arthritis and primary biliary cirrhosis. Rheumatol Int. 2015; 35:1913–1916. Recuperado de:
https://link.springer.com/article/10.1007%2Fs00296-015-3366-2
XII. Sargin G, Senturk T, Cildag S. Rituximab therapy in rheumatoid arthritis and primary biliary cholangitis. Reumatol Clin. 2017. Recuperado de:
https://doi.org/10.1016/j.reuma.2017.11.014.
XIII. P opp F, Semela D, von Kempis J, Mueller RB. Improvement of primary biliary cholangitis (PBC) under treatment with sulfasalazine and abatacept. BMJ Case Rep. 2018; doi:10.1136/ bcr-2018-224205. Recuperado de:
https://casereports.bmj.com/content/2018/bcr-2018-224205.long
XIV. Mousa H, Lleo A, Invernizzi P, Bowlus C, Gershwin M. Advances in pharmacotherapy for primary biliary cirrhosis. Expert Opin Pharmacother. 2015 April; 16(5): 633–643. Recuperado de:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591873/
XV. S myk D, Bogdanos DP, Mytilinaiou MG, Burroughs AK, Rigopoulou EI. Rheumatoid Arthritis and Primary Biliary Cirrhosis: Cause, Consequence, or Coincidence? Arthritis. 2012; doi:10.1155/2012/391567. Recuperado de:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488395/
Copyright (c) 2019 Argentine Journal of Rheumatology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
