Reactions Weekly | 2021
Methotrexate
Abstract
Lack of efficacy: case report A 55-year-old woman exhibited lack of efficacy during treatment with methotrexate for pan-ulcerative colitis (UC) and seronegative HLA-B27 spondyloarthritis (SpA). The woman, who had seronegative HLA-B27 SpA and pan-UC, had showed no response to adalimumab previously. She also had a history of intolerance to infliximab. In 2014, she presented with diarrhoea, abdominal pain and arthralgias. Her CRP was 5.4 mg/mL, and a colonoscopy revealed Mayo-2 pancolitis without dysplasia. She was treated with vedolizumab with a clinical response without remission. Hence, methotrexate [dosage and route not stated] was added; however, it was ineffective. She then underwent a repeat colonoscopy, which revealed Mayo-1 disease with chronic active colitis. She was treated with budesonide for persistent symptoms. Tofacitinib was added to the treatment in 2018. Subsequently, a steroid-free clinical remission was achieved. Six months later, a colonoscopy revealed normal colon with inactive colitis. Hence, vedolizumab frequency was reduced and vedolizumab was stopped. However, her stool frequency increased with inflammatory joint pain after 11 weeks, and vedolizumab was re-initiated with a remission.