Infliximab投与後に狭心症を来した関節リウマチの1例

Angina Pectoris after Infliximab Therapy in a Patient with Rheumatoid Arthritis

要旨　症例は15年前に関節リウマチと診断されてmethotrexate，predonine，非ステロイド系鎮痛薬で治療されてきた．不安定狭心症のため冠動脈バイパス手術を施行されている．その後の経過は良好であった．1年前に難治性の大腸潰瘍を来し，薬物治療を中止した．多関節痛が進行し，infliximabを投与した．多関節痛は消失した．しかし，infliximab投与後に胸痛出現し，再投与にて胸痛が再度出現した．infliximab中止後は胸痛もなく，関節リウマチの症状も増悪しなかった．この間心血管系の内服薬は変更しなかった．

　臨床医はinfliximabを開始する時にハイリスクの患者において，狭心症の増悪を来す可能性についても認識しておく必要がある．

　We report herein a very rare case where angina pectoris resulted following the administration of infliximab. A 74-year-old female had been diagnosed with rheumatoid arthritis(RA)15 years previously and was treated with methotrexate, predonine and non-steroidal anti-inflammatory drugs. She also had hypertension, diabetes, and dyslipidemia. The underlying diseases had been well controlled. A coronary artery bypass graft had been performed for unstable angina. There was little chest pain and the subsequent course was good. A refractory colonic ulcer appeared and this led to discontinuation of the drug treatments. Polyarthralgia developed, so infliximab was also given and the polyarthralgia disappeared. However, chest pain occurred after infliximab therapy, and reoccurred upon readministration. After the infliximab was discontinued, the patient experienced no further chest pain, and her RA symptoms were also no worse. During this time, cardiovascular medication remained unaltered. Clinicians should be aware that exacerbation of angina may occur in patients-especially high-risk patients-to whom infliximab is administered.