Aim: Multiple papers have reported the development of new-onset arthralgias with vedolizumab (VDZ) for the treatment of inflammatory bowel disease (IBD). Other studies have shown that VDZ may help in preexisting enteropathic spondyloarthropathy. We sought to probe this issue by conducting a systematic review. Methods: Embase, Medline, Cochrane Central, and Web of Science were searched up to June 29, 2020 for randomized controlled trials evaluating vedolizumab treatment in patients with IBD in which development of arthralgias was noted. Risk of bias and quality were assessed using Cochrane’s collaboration tool and the GRADE system, respectively. PROSPERO registration number: CRD42020197101. Results: Four hundred sixty-one discrete articles were retrieved. Five studies (n=2,899) met inclusion criteria. Comparing the risk of arthralgia in patients treated with VDZ and placebo yielded odds ratio’s which ranged between 1.01 (95% confidence interval (CI) 0.61-1.65) and 10.20 (95% CI: 0.53-195.78). While each study noted an increased incidence of arthralgias in patients receiving VDZ, none proved statistically significant. Studies were heterogeneous in disease populations, VDZ dosage, time-points for evaluation, and data points collected. Post-hoc analyses suggested an increased risk of arthralgias in patients with prior TNF inhibitor use. Conclusion: The included studies showed a trend toward increased arthralgias in patients with IBD who received VDZ. However, our study lacked any statistically significant findings to identify a clear link. More research is needed to substratify which patients develop arthralgias when treated with VDZ in order to better understand whether heightened risk can be predicted prior to treatment initiation.

Immunoglobulin G4 related disease (IgG4-RD) is a rare multisystem inflammatory disease, in which one of the main gastrointestinal manifestations is autoimmune pancreatitis (AIP) type 1. AIP type 1 is correlated with a clinical presentation of obstructive jaundice, increased serum levels of IgG4 and suggestive pancreatic findings on radiologic imaging. Histo-pathology (HP) and immune-histochemistry (IHC) examinations obtained by biopsy are the gold standard for establishing the diagnosis. Several theories tried to elucidate the correlation between IgG4-RD and pancreatic or other extra-pancreatic malignancies. There are controversial opinions whether AIP type 1 serves as a premalignant state, or whether these two conditions are coexistent. We present a patient who had clinical, laboratory, radiologic and histologic findings that were consistent with a pancreatic space occupying lesion (SOL). As a result, he underwent a Whipple operation, but the IHC findings were compatible with AIP type 1. After 1 year of remission, the patient presented with a new pancreatic SOL that was diagnosed as adenocarcinoma.

Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease that leads to joint destruction and disability. Despite a significant progress in administration of biological agents for RA patients, there is still a need for improved therapy. Intravenous-immunoglobulins (IVIG) , a pooled polyspecific immunoglobulin-G (IgG) extracted from 20,000 healthy subjects, showed beneficial therapeutic effect in patients with immune-deficiency, sepsis, and autoimmune diseases. The current study aim to investigate the beneficial effect of treatment with IVIG in established collagen induced arthritis in DBA/1j mice. Murine arthritis was induced in DBA/1j mice. The treatment with IVIG started when the disease was established. The clinical score was followed twice a week until day 48. The mice were bled for plasma, the paws were H&E stained. Cytokine profile in the plasma was analyzed by Luminex technology, titers of circulating anti-collagen antibodies in the plasma was tested by ELISA. Our results show that treatment with IVIG in murine, significantly rreduced the clinical arthritis score (P<0.001). Moreover, mode of action show that IVIG significantly reduced circulating level of inflammatory cytokines (IFN, IL-1β, IL-17, IL-6, TNFα) (P<0.001), inhibit anti-collagen antibodies (P < 0.001) in the plasma of CIA mice. Importantly, histopathological examination revealed that IVIG treatment prevented the migration of inflammatory immune cells into the cartilage and synovium, reduced the extent of joint damage and preserved joint architecture. Our results proved for the first time the valuable anti-inflammatory treatment of IVIG in experimental RA. We propose IVIG therapy for a subgroup of patients with as rheumatological-related diseases.