Successful treatment with infliximab in a patient with Crohn's disease and rheumatoid arthritis

Authors report on the association of Crohn's disease (CD) and rheumatoid arthritis (RA) in one patient. The diagnosis of CD was established on the base of clinical symptoms, colonoscopy, histology of terminal ileum, ultrasonography of the bowels, laboratory parameters, and gallium 67 scyntigraphy. Crohn's disease activity index (CDAI) and ultrasonography of the bowels were used at the follow up. CT enteroclysis controlled the degree of remission.

RA was diagnosed by the use of criteria of the American Rheumatological Association. Disease activity score (DAS-28), C reactive protein (CRP), and rheumatoid factor (RF) were controlled during the follow up.

The 53 years old female was hospitalized due to symptoms for eight month with recessing diarrhoea and painful swelling of her little joints of hands and feet. The diagnosis of RA in Steinbroker I-II stage was confirmed by RF. Colonoscopy revealed typical little ulcers and aphtoid lesions in the terminal ileum, histology proved terminal ileitis. Metilprednisolone (60mg/die), leflunomid (20mg), mesalazin (2000mg) therapy was initiated, but worsening of both diseases developed (DAS-28: 5,77, RF: 226,9 IU/ml, CRP: 200mg/l). High doses of Metilprednisolone (125mg/die), antibiotics (ofloxacin, metronidasol) and immunomodulatory therapy (Azathioprin 100mg) resulted in a complete remission of CD, but did not influence the activity of RA. After these partially successful therapies, the infliximab (Remicade) used at 0. 2. and 6. week, and followed in every 8. weeks in dose of 3mg/kg, with 100mg azathioprin basis therapy resulted in a whole remission both of CD (CDAI: 28) and RA (DAS-28: 3,19, RF: 15,2 IU/ml, CRP: 1,8mg/l).

Conclusion: according to our knowledge this two phenomenons have not reported in one patient yet. With this case report we would like to call attention to the earlier indication of infliximab treatment, which is accepted in both diseases.