Paraparesis due to exacerbation of preexisting spinal pseudoarthrosis following infliximab therapy for advanced ankylosing spondylitis
Recent reports have described the long-term efficacy and safety of infliximab as a treatment for ankylosing spondylitis (AS). The most important adverse effects of infliximab are infections, malignancies, autoimmunities, and hypersensitivity reactions. There has never been a reported case of parapar...
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| Veröffentlicht in: | The spine journal 2006-05, Vol.6 (3), p.325-329 |
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| creator | Sakaura, Hironobu Hosono, Noboru Mukai, Yoshihiro Fujii, Ryutaro Yoshikawa, Hideki |
| description | Recent reports have described the long-term efficacy and safety of infliximab as a treatment for ankylosing spondylitis (AS). The most important adverse effects of infliximab are infections, malignancies, autoimmunities, and hypersensitivity reactions. There has never been a reported case of paraparesis after infliximab therapy for AS.
To describe a case with paraparesis caused by rapid exacerbation of preexisting spinal pseudoarthrosis after infliximab therapy for advanced AS.
Case report/Osaka University Graduate School of Medicine, Suita, Japan.
A 55-year-old man with a 27-year history of AS.
Case report.
A 55-year-old man with a 27-year history of AS was treated with infliximab, which provided considerable pain relief and improvement of activities of daily living. However, as the patient resumed vigorous daily activity, he felt back pain and subsequently developed paraparesis. Radiographs showed rapid exacerbation of preexisting spinal pseudoarthrosis at the T11–T12 level after infliximab therapy.
After laminectomy and posterolateral fusion, the back pain and paraparesis improved sufficiently to allow independent walking, but moderate bladder dysfunction persisted.
Although this patient could have certainly become myelopathic over time without undergoing infliximab therapy, the patient's history and radiographic course suggest that suppression of inflammation by infliximab improved his activities of daily living, which paradoxically exacerbated preexisting spinal pseudoarthrosis and quickened the onset of subsequent myelopathy. |
| doi_str_mv | 10.1016/j.spinee.2005.10.012 |
| format | Article |
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To describe a case with paraparesis caused by rapid exacerbation of preexisting spinal pseudoarthrosis after infliximab therapy for advanced AS.
Case report/Osaka University Graduate School of Medicine, Suita, Japan.
A 55-year-old man with a 27-year history of AS.
Case report.
A 55-year-old man with a 27-year history of AS was treated with infliximab, which provided considerable pain relief and improvement of activities of daily living. However, as the patient resumed vigorous daily activity, he felt back pain and subsequently developed paraparesis. Radiographs showed rapid exacerbation of preexisting spinal pseudoarthrosis at the T11–T12 level after infliximab therapy.
After laminectomy and posterolateral fusion, the back pain and paraparesis improved sufficiently to allow independent walking, but moderate bladder dysfunction persisted.
Although this patient could have certainly become myelopathic over time without undergoing infliximab therapy, the patient's history and radiographic course suggest that suppression of inflammation by infliximab improved his activities of daily living, which paradoxically exacerbated preexisting spinal pseudoarthrosis and quickened the onset of subsequent myelopathy.</description><identifier>ISSN: 1529-9430</identifier><identifier>EISSN: 1878-1632</identifier><identifier>DOI: 10.1016/j.spinee.2005.10.012</identifier><identifier>PMID: 16651229</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Ankylosing spondylitis/complications ; Antibodies, Monoclonal - adverse effects ; Antirheumatic Agents - adverse effects ; Antirheumatic agents/therapeutic use ; C-Reactive Protein - analysis ; C-Reactive Protein - drug effects ; Comorbidity ; Humans ; Infliximab ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Monoclonal antibodies/therapeutic use ; Paraparesis - etiology ; Pseudarthrosis - physiopathology ; Pseudarthrosis - surgery ; Spinal Cord Compression - etiology ; Spinal Cord Compression - surgery ; Spinal Fusion ; Spondylitis, Ankylosing - complications ; Spondylitis, Ankylosing - drug therapy ; Thoracic Vertebrae - pathology ; Thoracic Vertebrae - surgery</subject><ispartof>The spine journal, 2006-05, Vol.6 (3), p.325-329</ispartof><rights>2006 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c275t-57f0ed7779824ab7488e256aee06cbe53460a4c7143a136f1d187d3a96535c73</citedby><cites>FETCH-LOGICAL-c275t-57f0ed7779824ab7488e256aee06cbe53460a4c7143a136f1d187d3a96535c73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S152994300501034X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16651229$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sakaura, Hironobu</creatorcontrib><creatorcontrib>Hosono, Noboru</creatorcontrib><creatorcontrib>Mukai, Yoshihiro</creatorcontrib><creatorcontrib>Fujii, Ryutaro</creatorcontrib><creatorcontrib>Yoshikawa, Hideki</creatorcontrib><title>Paraparesis due to exacerbation of preexisting spinal pseudoarthrosis following infliximab therapy for advanced ankylosing spondylitis</title><title>The spine journal</title><addtitle>Spine J</addtitle><description>Recent reports have described the long-term efficacy and safety of infliximab as a treatment for ankylosing spondylitis (AS). The most important adverse effects of infliximab are infections, malignancies, autoimmunities, and hypersensitivity reactions. There has never been a reported case of paraparesis after infliximab therapy for AS.
To describe a case with paraparesis caused by rapid exacerbation of preexisting spinal pseudoarthrosis after infliximab therapy for advanced AS.
Case report/Osaka University Graduate School of Medicine, Suita, Japan.
A 55-year-old man with a 27-year history of AS.
Case report.
A 55-year-old man with a 27-year history of AS was treated with infliximab, which provided considerable pain relief and improvement of activities of daily living. However, as the patient resumed vigorous daily activity, he felt back pain and subsequently developed paraparesis. Radiographs showed rapid exacerbation of preexisting spinal pseudoarthrosis at the T11–T12 level after infliximab therapy.
After laminectomy and posterolateral fusion, the back pain and paraparesis improved sufficiently to allow independent walking, but moderate bladder dysfunction persisted.
Although this patient could have certainly become myelopathic over time without undergoing infliximab therapy, the patient's history and radiographic course suggest that suppression of inflammation by infliximab improved his activities of daily living, which paradoxically exacerbated preexisting spinal pseudoarthrosis and quickened the onset of subsequent myelopathy.</description><subject>Ankylosing spondylitis/complications</subject><subject>Antibodies, Monoclonal - adverse effects</subject><subject>Antirheumatic Agents - adverse effects</subject><subject>Antirheumatic agents/therapeutic use</subject><subject>C-Reactive Protein - analysis</subject><subject>C-Reactive Protein - drug effects</subject><subject>Comorbidity</subject><subject>Humans</subject><subject>Infliximab</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Monoclonal antibodies/therapeutic use</subject><subject>Paraparesis - etiology</subject><subject>Pseudarthrosis - physiopathology</subject><subject>Pseudarthrosis - surgery</subject><subject>Spinal Cord Compression - etiology</subject><subject>Spinal Cord Compression - surgery</subject><subject>Spinal Fusion</subject><subject>Spondylitis, Ankylosing - complications</subject><subject>Spondylitis, Ankylosing - drug therapy</subject><subject>Thoracic Vertebrae - pathology</subject><subject>Thoracic Vertebrae - surgery</subject><issn>1529-9430</issn><issn>1878-1632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1u1DAUhS0EoqXtGyDkFbsM_ontZIOEqkKRKrWL7i3HvqEePHGwnXbmBXhuHGYkdqxs3XvOuTofQu8p2VBC5aftJs9-AtgwQkQdbQhlr9A57VTXUMnZ6_oXrG_6lpMz9C7nLSGkU5S9RWdUSkEZ68_R7weTzGwSZJ-xWwCXiGFvLKTBFB8nHEc8J4C9z8VPP_B60wQ8Z1hcNKk8pbg6xxhCfFkFfhqD3_udGXB5gpp9qMuEjXs2kwWHzfTzEKrnb1ac3CH44vMlejOakOHq9F6gx683j9e3zd39t-_XX-4ay5QojVAjAaeU6jvWmkG1XQdMSANApB1A8FYS01pFW24olyN1FYfjppeCC6v4Bfp4jJ1T_LVALnrns4UQzARxyVqqngnKRRW2R6Gt_XKCUc-pdkoHTYle8eutPuLXK_51WvFX24dT_jLswP0znXhXweejAGrJZw9JZ-thBeMT2KJd9P-_8Aeq05xX</recordid><startdate>200605</startdate><enddate>200605</enddate><creator>Sakaura, Hironobu</creator><creator>Hosono, Noboru</creator><creator>Mukai, Yoshihiro</creator><creator>Fujii, Ryutaro</creator><creator>Yoshikawa, Hideki</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200605</creationdate><title>Paraparesis due to exacerbation of preexisting spinal pseudoarthrosis following infliximab therapy for advanced ankylosing spondylitis</title><author>Sakaura, Hironobu ; Hosono, Noboru ; Mukai, Yoshihiro ; Fujii, Ryutaro ; Yoshikawa, Hideki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c275t-57f0ed7779824ab7488e256aee06cbe53460a4c7143a136f1d187d3a96535c73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Ankylosing spondylitis/complications</topic><topic>Antibodies, Monoclonal - adverse effects</topic><topic>Antirheumatic Agents - adverse effects</topic><topic>Antirheumatic agents/therapeutic use</topic><topic>C-Reactive Protein - analysis</topic><topic>C-Reactive Protein - drug effects</topic><topic>Comorbidity</topic><topic>Humans</topic><topic>Infliximab</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Monoclonal antibodies/therapeutic use</topic><topic>Paraparesis - etiology</topic><topic>Pseudarthrosis - physiopathology</topic><topic>Pseudarthrosis - surgery</topic><topic>Spinal Cord Compression - etiology</topic><topic>Spinal Cord Compression - surgery</topic><topic>Spinal Fusion</topic><topic>Spondylitis, Ankylosing - complications</topic><topic>Spondylitis, Ankylosing - drug therapy</topic><topic>Thoracic Vertebrae - pathology</topic><topic>Thoracic Vertebrae - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sakaura, Hironobu</creatorcontrib><creatorcontrib>Hosono, Noboru</creatorcontrib><creatorcontrib>Mukai, Yoshihiro</creatorcontrib><creatorcontrib>Fujii, Ryutaro</creatorcontrib><creatorcontrib>Yoshikawa, Hideki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sakaura, Hironobu</au><au>Hosono, Noboru</au><au>Mukai, Yoshihiro</au><au>Fujii, Ryutaro</au><au>Yoshikawa, Hideki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Paraparesis due to exacerbation of preexisting spinal pseudoarthrosis following infliximab therapy for advanced ankylosing spondylitis</atitle><jtitle>The spine journal</jtitle><addtitle>Spine J</addtitle><date>2006-05</date><risdate>2006</risdate><volume>6</volume><issue>3</issue><spage>325</spage><epage>329</epage><pages>325-329</pages><issn>1529-9430</issn><eissn>1878-1632</eissn><abstract>Recent reports have described the long-term efficacy and safety of infliximab as a treatment for ankylosing spondylitis (AS). The most important adverse effects of infliximab are infections, malignancies, autoimmunities, and hypersensitivity reactions. There has never been a reported case of paraparesis after infliximab therapy for AS.
To describe a case with paraparesis caused by rapid exacerbation of preexisting spinal pseudoarthrosis after infliximab therapy for advanced AS.
Case report/Osaka University Graduate School of Medicine, Suita, Japan.
A 55-year-old man with a 27-year history of AS.
Case report.
A 55-year-old man with a 27-year history of AS was treated with infliximab, which provided considerable pain relief and improvement of activities of daily living. However, as the patient resumed vigorous daily activity, he felt back pain and subsequently developed paraparesis. Radiographs showed rapid exacerbation of preexisting spinal pseudoarthrosis at the T11–T12 level after infliximab therapy.
After laminectomy and posterolateral fusion, the back pain and paraparesis improved sufficiently to allow independent walking, but moderate bladder dysfunction persisted.
Although this patient could have certainly become myelopathic over time without undergoing infliximab therapy, the patient's history and radiographic course suggest that suppression of inflammation by infliximab improved his activities of daily living, which paradoxically exacerbated preexisting spinal pseudoarthrosis and quickened the onset of subsequent myelopathy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>16651229</pmid><doi>10.1016/j.spinee.2005.10.012</doi><tpages>5</tpages></addata></record> |
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| subjects | Ankylosing spondylitis/complications Antibodies, Monoclonal - adverse effects Antirheumatic Agents - adverse effects Antirheumatic agents/therapeutic use C-Reactive Protein - analysis C-Reactive Protein - drug effects Comorbidity Humans Infliximab Magnetic Resonance Imaging Male Middle Aged Monoclonal antibodies/therapeutic use Paraparesis - etiology Pseudarthrosis - physiopathology Pseudarthrosis - surgery Spinal Cord Compression - etiology Spinal Cord Compression - surgery Spinal Fusion Spondylitis, Ankylosing - complications Spondylitis, Ankylosing - drug therapy Thoracic Vertebrae - pathology Thoracic Vertebrae - surgery |
| title | Paraparesis due to exacerbation of preexisting spinal pseudoarthrosis following infliximab therapy for advanced ankylosing spondylitis |
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