Possible new onset or worsening of sacroiliitis or arthritis in people taking vedolizumab for IBD Vedolizumab might induce arthritis or sacroiliitis in people with IBD
INTRODUCTION
Inflammatory bowel disease (often shortened to IBD) is a long-term condition that affects a person’s digestive tract. IBD includes two conditions: ulcerative colitis and Crohn’s disease, which share many symptoms, such as diarrhoea, pain and weight loss. IBD is often linked to a type of inflammation of the joint called spondyloarthritis. Spondyloarthritis is an umbrella term for several types of joint inflammation that share many features and symptoms. Spondyloarthritis often affects the sacroiliac joint (in the back part of the pelvis) causing back pain and stiffness.
Vedolizumab (also called Entyvio) is a medicine for people with IBD that works by blocking certain signals between immune cells and the blood vessels in the gut. This helps to control inflammation and limit the symptoms of the disease.
WHAT DID THE AUTHORS HOPE TO COMMUNICATE?
The authors came across some new and unexpected findings in five people with IBD who were treated with
vedolizumab.
WHO WAS STUDIED?
This study looked at five people with IBD who were treated with vedolizumab and soon after developed joint symptoms, such as back pain (sacroiliitis) or joint swelling (arthritis) mimicking spondyloarthritis.
HOW WAS THE STUDY CONDUCTED?
The authors had found that people with IBD reported joint pain after treatment with vedolizumab, and they asked their colleagues whether they had seen any similar joint problems in their patients. They collected information on five people with IBD who were treated with vedolizumab and soon after developed joint symptoms.
WHAT WERE THE MAIN FINDINGS OF THE STUDY?
The authors found that vedolizumab does not seem to improve the symptoms of arthritis, and might even cause sacroiliitis or arthritis to develop in people with IBD. Additionally, inflammation in the affected joints was seen on images obtained by ultrasound scans and magnetic resonance imaging (MRI).
ARE THESE FINDINGS NEW?
Although some joint symptoms were reported in the clinical trials of vedolizumab, no mention was made of arthritis or sacroiliitis. This is the first report of the effect of vedolizumab on non-gut symptoms in people treated in general clinical practice.
WHAT ARE THE LIMITATIONS OF THIS STUDY?
The main limitation is that this is an observational case series that looks at a very small number of people. However, the authors are confident that the people included are typical IBD patients and that the findings are supported by measurements of inflammation through imaging.
WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
The authors feel that larger studies and clinical trials are needed to provide information on how many people with IBD might be affected in this way, and if there are any features that might make people with IBD who are treated with vedolizumab more likely to develop arthritis.
WHAT DOES THIS MEAN FOR ME?
People with IBD and their doctors should be aware of the link between IBD and joint inflammation. If you have IBD, you should let your doctor know if you experience any joint pain or swelling, no matter what treatment you are receiving. Because vedolizumab is a relatively new medicine, it has what is called “black triangle status”. This means that all suspected side effects to the drug have to be reported.
If you are receiving vedolizumab for your IBD, it is very important that you do not stop taking your medicine without talking to your doctor first.
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Date prepared: May 2017
Summary based on research article published on: 29 November 2016
From: Varkas, G. et al. An induction or flare of arthritis and/or sacroiliitis by vedolizumab in inflammatory bowel disease: a case series. Ann Rheum Dis 2017;76:878–81. doi:10.1136/annrheumdis-2016-210233.
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