Articles| Volume 333, ISSUE 3, P137-139, March 2007

Download started.


Tumor Necrosis Factor-α Inhibitor Associated Ulcerative Colitis



      Flares or onset of inflammatory bowel disease in association with immunosuppression has been reported in the literature.


      We studied 4 cases of patients with rheumatic disease who developed or had a flare of ulcerative colitis either after initiation of or while taking a tumor necrosis factor-α inhibitor.


      We identified 4 patients, three male and one female. Two of the male patients had a seronegative spondyloarthropathy and one had rheumatoid arthritis. The female patient had amyopathic dermatomyositis. Two of the 4 patients had ulcerative colitis prior to tumor necrosis factor-α treatment. Both of these patients had quiescent ulcerative colitis that flared after they began taking etanercept. Two patients developed de novo ulcerative colitis while taking a tumor necrosis factor-α inhibitor.


      The data presented in these 4 cases supports a temporal relationship between initiating a tumor necrosis factor-α inhibitor and onset or flare of ulcerative colitis. These observations raise the possibility that tumor necrosis factor-α inhibitor therapy, which has been used as treatment for inflammatory bowel disease, may rarely be a factor in the development of disease.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Davis J.
        • van der Heijde Braun J.
        • Dougados M.
        Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis.
        Arthritis Rheum. 2003; 48: 3230-3236
        • Marzo-Ortega H.
        • McGonagle D.
        • O’Connor P.
        Efficacy of etanercept for treatment of Crohn’s related spondyloarthritis but not colitis.
        Ann Rheum Dis. 2003; 62: 74-76
        • Ruemmele F.M.
        • Prieur A.M.
        • Talbotec C.
        Development of Crohn disease during anti-TNF-α therapy in a child with juvenile idiopathic arthritis.
        J Pediatr Gastroenterol Nutr. 2004; 39: 203-206
        • Jungling B.
        • Kindermann I.
        • Moser C.
        Development of ulcerative colitis after heart transplantation during immunosuppressive therapy.
        Z Gastroenterol. 2005; 43: 195-204
        • Palucka A.K.
        • Blanck J.P.
        • Bennett L.
        • et al.
        Cross-regulation of TNF and IFN-α in autoimmune diseases.
        Proc Natl Acad Sci. 2005; 102: 3372-3377
        • Sandborn W.J.
        Strategies for targeting tumor necrosis factor in IBD.
        Best Pract Res Clin Gastroenterol. 2003; 17: 105-117
        • Sandborn W.J.
        New concepts in anti-tumor necrosis factor therapy for inflammatory bowel disease.
        Rev Gastroenterol Disord. 2005; 5: 10-18