Öz
Thrombocytosis is a condition that is often detected incidentally and can be seen both in the course of myeloproliferative diseases (MPD) and as a reactive condition. Ankylosing spondylitis (AS) is a chronic multisystemic inflammatory disease that mainly affects the spine. Mild to moderate thrombocytosis may occur secondary to the course of AS. In the treatment of AS, tumor necrosis factor inhibitor (anti-TNF) treatments are actively used as first-line therapy. The number of cases of MPDs occurring in the course of AS reported in the literature is limited. Although the exact effect of anti-TNF treatment on the MPD process is not fully known, there are publications stating that caution should be exercised in cases of MPD. By this case, we wanted to share our experience of using anti-TNF therapy in a patient diagnosed with ET in the course of AS. The 35-year-old male patient had been diagnosed with AS for 11 years and had been followed up by hematology with the diagnosis of essential thrombocytosis (ET) since 2010. When there was no response to indomethacin and sulfasalazine treatments, the patient was first given etanercept, and after secondary unresponsiveness, infliximab and adalimumab treatments were given. Despite the use of multiple anti-TNFs, no hematological deterioration was detected in terms of ET. Clinical and laboratory responses were also obtained in terms of AS. The patient has been stable and in remission in terms of both AS and ET since 2016.
Anahtar Kelimeler
essential thrombocytosis ankylosing spondylitis AS ET anti-TNF
Kaynakça
- 1. Schafer AI. Thrombocytosis. New England Journal of Medicine. 2004;350(12):1211-9. DOI: 10.1056/NEJMra0353 63
- 2. Deng L, Zheng P. Thrombocytosis in patients with spondyloarthritis: a case–control study. BMC Musculoskeletal Disorders. 2023;24(1):195. DOI: 10.1186/ s12891-023-06304-1
- 3. Tefferi A, Vannucchi AM, Barbui T. Essential thrombocythemia: 2024 update on diagnosis, risk stratification, and management. Am J Hematol. 2024;99(4):697-718. DOI: 10.1002/ajh.27216
- 4. Fischer M, Helper DJ, Chiorean MV. Myeloproliferative disorders in patients with inflammatory bowel disease on anti-TNF-α therapy: Report of two cases and review of the literature. Inflammatory Bowel Diseases. 2010;17(2):674-5. DOI: 10.1002/ibd.21291
- 5. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991;34(10):1218-27. doi: 10.1002/art.1780341003.
- 6. Ayvaz OC, Yavasoglu I, Kadikoylu G, Bozkurt G, Bolaman Z. Thrombocytosis in rheumatoid arthritis: JAK2V617F-positive essential thrombocythemia. Rheumatol Int. 2012;32(1):269-71. doi: 10.1007/s00296-010-1747-0.
- 7. Barbui T, Barosi G, Grossi A, Gugliotta L, Liberato LN, Marchetti M, et al. Practice guidelines for the therapy of essential thrombocythemia. A statement from the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation. Haematologica. 2004;89(2):215-32. PMID: 15003898
- 8. Di Minno MN, Iervolino S, Lupoli R, Russolillo A, Coppola A, Peluso R, et al. Cardiovascular risk in rheumatic patients: the link between inflammation and atherothrombosis. Semin Thromb Hemost. 2012;38(5):497-505. doi: 10.1055/s-0032-1306433.
- 9. Khanna D, McMahon M, Furst DE. Safety of tumour necrosis factor-alpha antagonists. Drug Saf. 2004;27(5):307-24. doi: 10.2165/00002018-200427050-00003.
- 10. Önmez A, Altun G, Akbaş T, Öneç B. Etanercept-Induced Thrombocytopenia In A Patient With Ankylosing Spondylitis. DAHUDER Medical Journal. 2022;2(1):28-9.
- 11. Epistola R, Do T, Vankina R, Wu D, Yeh J, Fleischman MW, Lee JM. Immune Thrombocytopenic Purpura (ITP) as an Uncommon Extraintestinal Complication of Crohn's Disease: Case Vignette and Systematic Literature Review. Case Rep Hematol. 2020;2020:4785759. doi: 10.1155/2020/4785759
- 12. Braun J, Sieper J. Therapy of ankylosing spondylitis and other spondyloarthritides: established medical treatment, anti-TNF-α therapy and other novel approaches. Arthritis Research & Therapy. 2002;4(5):307. doi: 10.1186/ar592
Öz
Trombositoz sıklıkla tesadüfen tespit edilen ve hem miyeloproliferatif hastalıkların (MPH) seyrinde hem de reaktif bir durum olarak görülebilen bir durumdur. Ankilozan spondilit (AS), esas olarak omurgayı etkileyen kronik, multisistemik inflamatuar bir hastalıktır. AS'nin seyrine sekonder olarak hafif ila orta şiddette trombositoz meydana gelebilir. AS tedavisinde tümör nekroz faktör inhibitörü (anti-TNF) tedavileri birinci basamak tedavide aktif olarak kullanılmaktadır. Literatürde AS seyrinde ortaya çıkan MPH vakalarının sayısı sınırlıdır. Anti-TNF tedavisinin MPH sürecine etkisi tam olarak bilinmemekle birlikte bu vakalarda dikkatli olunması gerektiğini belirten yayınlar bulunmaktadır. Bu olguyla AS seyrinde ET tanısı alan bir hastada anti-TNF tedavisi kullanma deneyimimizi paylaşmak istedik. 35 yaşındaki erkek hastada 11 yıldır AS tanısı mevcuttu, 2010'dan beridir ise esansiyel trombositoz (ET) tanısı ile hematoloji tarafından takipliydi. Indometazin ve sulfasalazin tedavilerine yanıt alınamayınca hastaya önce etanercept, sekonder yanıtsızlık üzerine de infliksimab ve adalimumab tedavileri verildi. Çoklu anti-TNF kullanımına rağmen ET açısından herhangi bir hematolojik bozulma saptanmadı. AS açısından da klinik ve laboratuvar yanıtı alındı. Hasta 2016 yılından bu yana hem AS hem de ET açısından stabil ve remisyonda izlenmektedir.
Anahtar Kelimeler
Kaynakça
- 1. Schafer AI. Thrombocytosis. New England Journal of Medicine. 2004;350(12):1211-9. DOI: 10.1056/NEJMra0353 63
- 2. Deng L, Zheng P. Thrombocytosis in patients with spondyloarthritis: a case–control study. BMC Musculoskeletal Disorders. 2023;24(1):195. DOI: 10.1186/ s12891-023-06304-1
- 3. Tefferi A, Vannucchi AM, Barbui T. Essential thrombocythemia: 2024 update on diagnosis, risk stratification, and management. Am J Hematol. 2024;99(4):697-718. DOI: 10.1002/ajh.27216
- 4. Fischer M, Helper DJ, Chiorean MV. Myeloproliferative disorders in patients with inflammatory bowel disease on anti-TNF-α therapy: Report of two cases and review of the literature. Inflammatory Bowel Diseases. 2010;17(2):674-5. DOI: 10.1002/ibd.21291
- 5. Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991;34(10):1218-27. doi: 10.1002/art.1780341003.
- 6. Ayvaz OC, Yavasoglu I, Kadikoylu G, Bozkurt G, Bolaman Z. Thrombocytosis in rheumatoid arthritis: JAK2V617F-positive essential thrombocythemia. Rheumatol Int. 2012;32(1):269-71. doi: 10.1007/s00296-010-1747-0.
- 7. Barbui T, Barosi G, Grossi A, Gugliotta L, Liberato LN, Marchetti M, et al. Practice guidelines for the therapy of essential thrombocythemia. A statement from the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation. Haematologica. 2004;89(2):215-32. PMID: 15003898
- 8. Di Minno MN, Iervolino S, Lupoli R, Russolillo A, Coppola A, Peluso R, et al. Cardiovascular risk in rheumatic patients: the link between inflammation and atherothrombosis. Semin Thromb Hemost. 2012;38(5):497-505. doi: 10.1055/s-0032-1306433.
- 9. Khanna D, McMahon M, Furst DE. Safety of tumour necrosis factor-alpha antagonists. Drug Saf. 2004;27(5):307-24. doi: 10.2165/00002018-200427050-00003.
- 10. Önmez A, Altun G, Akbaş T, Öneç B. Etanercept-Induced Thrombocytopenia In A Patient With Ankylosing Spondylitis. DAHUDER Medical Journal. 2022;2(1):28-9.
- 11. Epistola R, Do T, Vankina R, Wu D, Yeh J, Fleischman MW, Lee JM. Immune Thrombocytopenic Purpura (ITP) as an Uncommon Extraintestinal Complication of Crohn's Disease: Case Vignette and Systematic Literature Review. Case Rep Hematol. 2020;2020:4785759. doi: 10.1155/2020/4785759
- 12. Braun J, Sieper J. Therapy of ankylosing spondylitis and other spondyloarthritides: established medical treatment, anti-TNF-α therapy and other novel approaches. Arthritis Research & Therapy. 2002;4(5):307. doi: 10.1186/ar592
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Tıp Eğitimi |
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Erken Görünüm Tarihi | 29 Mart 2025 |
| Yayımlanma Tarihi | 29 Mart 2025 |
| Gönderilme Tarihi | 3 Ocak 2025 |
| Kabul Tarihi | 4 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 47 Sayı: 1 |
