Adalimumab

Abstract

Paradoxical reaction in the form of Takayasu’s arteritis: case report A 43-year-old man developed paradoxical reactions in the form of Takayasu’s arteritis during treatment with adalimumab for spondyloarthritis. The man was diagnosed with axial spondyloarthritis in 2015. Initially, he received unspecified NSAID for one year but without satisfactory clinical improvement. Therefore, he was treated with adalimumab for two and a half years with complete remission [dosage and route not stated]. In January 2019, he presented a transient ischaemic attack with a normal cerebral angioscan. On admission, he was asymptomatic and the history gave no clue of an ongoing vasculitis. The clinical examination revealed comparable normal blood pressure values in both arms but slightly decreased radial and pedal pulses. The pulse in the extremities was hardly detectable, with presence of a bilateral umbilical bruit, bilateral carotid bruit and a right subclavian artery bruit. A thoracic angio-CT scan showed the presence of multiple significant stenoses of the supraaortic arteries and both renal arteries were also constricted with celiac trunk stenosis of 60%. The laboratory tests showed elevated inflammation markers. He was diagnosed with Takayasu’s arteritis stage 5 and was considered to be paradoxical side effect [duration of treatment to reaction onset not stated]. Thus, adalimumab was stopped and he underwent a 3-day regimen of methylprednisolone followed by prednisone. Methotrexate was maintained at weekly dose. He achieved a good response with the treatment with normalisation of the inflammatory parameters