Effect of Ixekizumab on Enthesitis-related arthritis non-responsive to anti-TNF treatment, a case report

Abstract

AbstractBackground:To describe the effectiveness of Ixekizumab on a patient with ERA who was refractory to conventional treatment and TNF inhibitors.Case presentation:A 15-year-old boy who manifested as swollen knees, bilateral ankle arthritis, sausage toes and low-grade fever was diagnosed as Enthesitis related arthritis. There was one episode of uveitis three years before the onset of joint symptoms. The patient had a high level of inflammation (ESR to 107 mm/hour, CRP to 248.77 mg/L) with increased level of serum IL-6 and VEGF. Combination therapy of NSAIDs with sulfasalazine, Adalimumab, Infliximab, low dose steroid, Golimumab and Tofacitinib were applied correspondingly. The systemic inflammation of this patient (not including swollen toes and enthesitis) got a little better with oral steroids, but intensified again when steroid was weaned. Ixekizumab (80mg, Q2W twice, then 80mg Q4W) combined with oral methotrexate were then applied for this patient. ESR and CRP decreased into normal level with quick alleviation of arthritis within the first month of treatment. A persistent clinical remission was achieved by using Ixekizumab in the following two years of therapy. Apart from slight redness and swelling at the injection site, no significant side effects were observed during follow up.Conclusion:Ixekizumab can be a substitutive therapy for ERA patients who were unresponsive to traditional therapy or anti-TNF treatment.