Reactions 1368 - 10 Sep 2011

SOctreotide

Rheumatoid arthritis: case reportA 53-year-old woman with metastatic neuroendocrine

tumour of the pancreas developed rheumatoid arthritisduring treatment with octreotide [Sandostatin LAR depot]for facial flushing and diarrhoea.

The patient initially received subcutaneous andintramuscular doses of octreotide at 20mg, and this wassubsequently increased to 30mg intramuscular doses[frequency not stated]. During her 45th course of treatmentat 30 mg/dose, she reported joint pain in her hands andfeet, joint stiffness associated with intermittent swelling,primarily apparent in the mornings.

Physical examination, laboratory tests and imagingstudies were normal except for elevated glucose levels of334 mg/dL, elevated erythrocyte sedimentation rate of51 mm/hr, and cancer-related lesions which had remainedstable since previous assessments. The woman’s paininvolved the proximal interphalangeal,metacarpophalangeal, wrist and ankle joints, and she metthe required four of seven criteria for a diagnosis ofrheumatoid arthritis.

The patient’s dose of octreotide was reduced from 30mgto 20mg with a 50% improvement in pain and greatlyreduced swelling, whilst control of facial flushing anddiarrhoea was adequately maintained.

Author comment: "To further assess this association, weused the Naranjo algorithm . . . Our patient’s total score was7. Based on the Naranjo nomogram our patient had probableadverse drug reaction."Saif MW. Rheumatoid arthritis associated with the use of sandostatin LAR depotin a patient with pancreatic neuroendocrine tumor. An association or acoincidence? the first case report. Journal of the Pancreas 12: 425-428, No. 4, 8 Jul2011 - USA 803059688

1

Reactions 10 Sep 2011 No. 13680114-9954/10/1368-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved