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Rheumatology 2000; 39: 182-184
© 2000 British Society for Rheumatology

Case Report

Dramatic response after an intravenous loading dose of azathioprine in one case of severe and refractory ankylosing spondylitis

P. Durez3 and Y. Horsmans1

Department of Rheumatology, Hôpital Erasme, Université Libre de Bruxelles, 808 route de Lennik, B-1070 Brussels and
1 Department of Gastroenterology, Louvain Medical School, Louvain, Belgium

We describe a 37-yr-old Caucasian male suffering from ankylosing spondylitis (AS) with long-standing severe inflammatory lumbar pain and hip arthritis who was refractory to non-steroidal anti-inflammatory drugs, sulphasalazine and methotrexate up to 25 mg/week. In this patient, administration of an i.v. loading dose of azathioprine (AZA; 40 mg/kg for 36 h followed by 2 mg/kg oral AZA therapy) induced a dramatic response in his clinical condition. Indeed, objective and subjective clinical variables improved within 1 week and were corroborated by a decline in the levels of the inflammatory parameters; anaemia was reported at month 3 but was rapidly reversible. If confirmed, an i.v. loading dose of AZA could represent a valuable alternative in severe and refractory AS, but toxicity of this regimen should be carefully analysed.

KEY WORDS: Ankylosing spondylitis, Intravenous azathioprine

3 Correspondence to: P. Durez.


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