The 69-year-old male patient had been suffering from periodically relapsing rheumatological symptoms involving variable localisations (knee, ankle, MTP, sternoclavicular and hip joint) since 1964. On the basis of his joint symptoms, loadindependent lower back pain, sacroileitis, recurrent iridocyclitis, urethroprostatitis and oral aphtous lesions, Reiter disease was diagnosed in 2000. The patient had Lyme-disease (confirmed Borrelia burgdorferi seropositivity) with peripheral facial paresis in 2003. The patient's joint problems relapsed in 2006, accompanied by diarrhoea and fever, independent of any infecions. The possibility of IBD could not be confirmed either by macroscopic examination using colonoscopy or hystology. The patient was admitted to our department in March 2008 for the first time, presenting again with joint pain and disability of gait, 7-8 bowel movements a day, and fever. Taken together the clinical symptoms, the typical radiological findings and HLA-B27 positivity, Bechterew disease was diagnosed. Colonoscopy performed because of diarrhea revealed multiple segmental aphtoid lesions and irregular ulcers, suggesting Crohn disease that was confirmed by histology (cryptal abscess formation and microgranulomas). Sulfasalazin, 5-ASA, and other NSAIDs applied to treat rheumatological symptoms could not eliminate either the gastrointestinal or the rheumatological symptoms of the patient, which necessitated regular steroid therapy. Because of the patient's steroid dependency, and considering his rheumatological symptoms, in June 2008 he was treated with adalimumab (ADA) induction therapy (80-40-40 mg s.c). In two weeks, his gastrointestinal as well as extraintestinal symptoms substantially improved, and completely diminished through the course of maintenance ADA therapy (40mg weekly). The patient is still asymptomatic and is excercising (jogging) regularly.
|Translated title of the contribution||Effective adalimumab treatment of a steroid-dependent Crohns' disease patient suffering from general, abdominal and joint symptoms of multiple Etiology|
|Number of pages||8|
|Journal||Lege Artis Medicinae|
|Publication status||Published - Jan 1 2011|
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