https://doi.org/10.4081/reumatismo.2024.1620
A rare case of symptomatic creatine kinase elevation in a patient with rheumatoid arthritis treated with baricitinib
Submitted: 21 July 2023
Accepted: 31 January 2024
Published: 24 June 2024
Accepted: 31 January 2024
Abstract Views: 1072
PDF: 378
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The safety profile of baricitinib (BARI), a Janus kinase inhibitor broadly used for the treatment of rheumatoid arthritis (RA), includes asymptomatic laboratory abnormalities, such as an increase in creatine kinase (CK). Data from randomized controlled trials suggest that concomitant myalgia is rare in RA and does not lead to drug discontinuation. We describe the case of a 68-year-old Caucasian female with longstanding, multi-failure RA who started BARI and achieved disease remission. However, she developed a symptomatic CK increase, as well as a parallel increase in total cholesterol, low-density lipoprotein, and triglycerides. Dechallenge-rechallenge demonstrated a plausible relationship between the clinical/laboratory abnormalities and BARI. In fact, when the drug was withdrawn, CK returned to normal and myalgia disappeared, whereas symptoms returned and CK levels increased when BARI was restarted. BARI may be rarely associated with symptomatic CK elevation, and this may pose clinical challenges, particularly for patients with multi-failure RA who achieved good disease control with BARI but required drug discontinuation due to intolerance.
Tanaka Y, Luo Y, O’Shea JJ, Nakayamada S. Janus kinase-targeting therapies in rheumatology: a mechanisms-based approach. Nat Rev Rheumatol 2022; 18: 133-45.
DOI: https://doi.org/10.1038/s41584-021-00726-8
Dai ZH, Xu XT, Ran ZH. Associations between obesity and the effectiveness of anti-tumor necrosis factor-α agents in inflammatory bowel disease patients: a literature review and meta-analysis. Ann Pharmacother 2020; 54: 729-41.
DOI: https://doi.org/10.1177/1060028019900660
Anjara P, Jiang M, Mundae M. Symptomatic elevation creatine kinase following treatment of rheumatoid arthritis with baricitinib. Clin Rheumatol 2020; 39: 613-4.
DOI: https://doi.org/10.1007/s10067-019-04833-6
Smolen JS, Genovese MC, Takeuchi T, Hyslop DL, Macias WL, Rooney T, et al. Safety profile of baricitinib in patients with active rheumatoid arthritis with over 2 years median time in treatment. J Rheumatol 2019; 46:7-18. Erratum in: J Rheumatol 2019; 46: 1648-9.
DOI: https://doi.org/10.3899/jrheum.171361
Bieber T, Thyssen JP, Reich K, Simpson EL, Katoh N, Torrelo A, et al. Pooled safety analysis of baricitinib in adult patients with atopic dermatitis from 8 randomized clinical trials. J Eur Acad Dermatol Venereol 2021; 35: 476-85.
DOI: https://doi.org/10.1111/jdv.16948
Queeney KL, Housley WJ, Sokolov J, Long A. FRI0131 elucidating the mechanism underlying creatine phosphokinase upregulation with upadacitinib. Ann Rheum Dis 2019; 78: 734-5.
DOI: https://doi.org/10.1136/annrheumdis-2019-eular.7509
Reffat D, O’Riordan A, Adeeb F. Baricitinib plus leflunomide: a potentially dangerous combination? Clin Exp Rheumatol 2021; 39 Suppl 128: 31-2.
Taylor PC, Takeuchi T, Burmester GR, Durez P, Smolen JS, Deberdt W, et al. Safety of baricitinib for the treatment of rheumatoid arthritis over a median of 4.6 and up to 9.3 years of treatment: final results from long-term extension study and integrated database. Ann Rheum Dis 2022; 81: 335-43
DOI: https://doi.org/10.1136/annrheumdis-2021-221276
Zhao Q, Zhu Z, Fu Q, Shih Y, Wu D, Chen L, et al. Baricitinib for the treatment of cutaneous dermatomyositis: a prospective, open-label study. J Am Acad Dermatol 2022; 87: 1374-6.
DOI: https://doi.org/10.1016/j.jaad.2022.08.025
Delvino P, Bartoletti A, Monti S, Biglia A, Montecucco C, Carducci M, et al. Successful treatment with baricitinib in a patient with refractory cutaneous dermatomyositis. Rheumatology (Oxford) 2020; 59: e125-7.
DOI: https://doi.org/10.1093/rheumatology/keaa184
Fischer K, Aringer M, Steininger J, Heil J, Beissert S, Abraham S, et al. Improvement of cutaneous inflammation and panniculitis in patients with dermatomyositis by the Janus kinase inhibitor baricitinib. Br J Dermatol 2022; 187: 432-5.
DOI: https://doi.org/10.1111/bjd.21252
Walsh RJ, Kong SW, Yao Y, Jallal B, Kiener PA, Pinkus JL, et al. Type I interferon-inducible gene expression in blood is present and reflects disease activity in dermatomyositis and polymyositis. Arthritis Rheum 2007; 56: 3784-92.
DOI: https://doi.org/10.1002/art.22928
How to Cite
Mariani, F., Alunno, A., Carubbi, F., & Ferri, C. (2024). A rare case of symptomatic creatine kinase elevation in a patient with rheumatoid arthritis treated with baricitinib. Reumatismo, 76(2). https://doi.org/10.4081/reumatismo.2024.1620
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Similar Articles
- A. Alunno, O. Bistoni, F. Pratesi, F. Topini, I. Puxeddu, V. Valentini, G. Cafaro, E. Bartoloni, P. Migliorini, R. Gerli, Association between anti-citrullinated alpha enolase antibodies and clinical features in a cohort of patients with rheumatoid arthritis: a pilot study , Reumatismo: Vol. 70 No. 2 (2018)
- M. Rossini, O Viapiana, G. Orsolini, E. Fracassi, L. Idolazzi, D. Gatti, S. Adami, M. Govoni, Why golimumab in the treatment of psoriatic arthritis, ankylosing spondylitis and rheumatoid arthritis? , Reumatismo: Vol. 66 No. 4 (2014)
- K.T. Koh, C.L. Teh, C.K. Cheah, G.R. Ling, M.C. Yong, H.C. Hong, S.C. Gun, Real-world experiences of folic acid supplementation (5 versus 30 mg/week) with methotrexate in rheumatoid arthritis patients: a comparison study , Reumatismo: Vol. 68 No. 2 (2016)
- A. Fassio, L. Idolazzi, M. Rossini, O. Viapiana, D. Gatti, A case of mandible Paget’s disease of the bone treated with intravenous neridronate , Reumatismo: Vol. 68 No. 3 (2016)
- E. Lubrano, R. Scarpa, Psoriatic arthritis: treatment strategies using anti-inflammatory drugs and classical DMARDs , Reumatismo: Vol. 64 No. 2 (2012)
- F. Craig, C. Bellintani, S. Goffredo, How will I be when I will grow up? The importance of psychological intervention in pediatric patients to prevent symptoms from becoming chronical , Reumatismo: Vol. 65 No. 5 (2013)
- G. Andrisani, E. Gremese, L. Guidi, A. Papa, M. Marzo, C. Felice, D. Pugliese, A. Armuzzi, Achievement of sustained deep remission with adalimumab in a patient with both refractory ulcerative colitis and seronegative erosive rheumatoid arthritis , Reumatismo: Vol. 65 No. 2 (2013)
- G. Turchetti, S. Bellelli, M. Mosca, The social cost of rheumatoid arthritis in Italy: the results of an estimation exercise , Reumatismo: Vol. 65 No. 6 (2013)
- N. Maruotti, A. Corrado, F.P. Cantatore, Osteoporosis and rheumatic diseases , Reumatismo: Vol. 66 No. 2 (2014)
- G. Pasero, P. Marson, A short history of anti-rheumatic therapy - VI. Rheumatoid arthritis drugs , Reumatismo: Vol. 63 No. 2 (2011)
<< < 1 2 3 4 5 6 7 8 9 10 > >>
You may also start an advanced similarity search for this article.
