With low-dose aspirin and calcium channel blockers the severity and period of RP were decreased, and symptoms brought under control. antibody of the immunoglobulin G1/ isotype that selectively binds to and neutralizes interleukin (IL)-17A.4 Studies have shown Rabbit Polyclonal to MUC7 that secukinumab is an effective treatment option for active AS and psoriatic arthritis patients.5 However, accounts from clinical experience regarding the safety of this drug are lacking. The most frequently reported side Phthalylsulfacetamide effects are upper respiratory tract contamination, herpes labialis, and diarrhea. Raynauds phenomenon (RP) is usually a well-defined clinical syndrome characterized by recurrent digital vasospasm brought on by exposure to chemical or emotional stress.6 It is characterized by three unique color changes (pallor, cyanosis, and erythema) and may lead to ischemia and necrosis of the Phthalylsulfacetamide involved digits.7 RP is classified as main (as an isolated condition) or secondary (associated with an underlying disease). Secondary RP is usually most frequently associated with connective tissue diseases including systemic sclerosis, lupus, and Sj?grens syndrome; it is not an expected obtaining in patients diagnosed with AS. Herein, we statement the development of secukinumab-related RP in a 35-year-old female patient with AS. Case statement In 2019, a 35-year-old female patient was referred to our rheumatology outpatient medical center with complaints of inflammatory lower back and hip pain and morning stiffness. Approximately 8?years earlier, she had been diagnosed with AS and received treatment in the form of medications including NSAIDs, leflunomide, and Phthalylsulfacetamide methotrexate. In 2016, anti-TNF-alpha drugs also were prescribed but resulted in no improvement of symptoms. In the year prior to her introduction at our medical center, treatment experienced consisted solely of NSAIDs and exercise. At the time of physical examination, bilateral Flexion Abduction External Rotation (FABERE)Flexion Adduction Internal Rotation (FADIR) and sacroiliac joints compression tests were positive. The results of anthropometric measurement included handCground distance: 12?cm, occiputCwall distance: 2?cm, Shr?ber test: 3?cm, and chest growth: 3?cm. Disease activity parameters (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI): 8?cm, Bath Ankylosing Spondylitis Functional Index (BASFI): 6?cm) were found to be high. Laboratory tests revealed an erythrocyte sedimentation rate (ESR) of 54?mm/h (normal 0C20?mm/h), a C-reactive protein (CRP) rate of 15?mg/dl (normal 0C5?mg/dl), and a complete blood count compatible with chronic disease anemia; liver and kidney function assessments and urinalysis were found to be normal. HLA-B27 was positive. Abdominal ultrasonography and chest X-ray were normal. Bilateral chronic sacroiliitis was evaluated as stage 2 on X-ray. Cervical, thoracic, and lumbar radiographs showed joint space narrowing and syndesmophytes. A sacroiliac joints MRI revealed bilateral chronic sacroiliitis and bone marrow edema in favor of active sacroiliitis. These clinical, laboratory, and radiological findings confirmed AS disease activation. Anti-TNF-alpha treatment was not considered as she experienced experienced no benefit from it previously. The anti-IL17A drug secukinumab was started according to standard AS protocol. In the third month of the treatment, the patient came to the control visit. While she reported significant regression Phthalylsulfacetamide of subjective complaints such as back/hip pain, and morning stiffness, within hours of receiving secukinumab, she also reported having experienced changes in the color (pallor, cyanosis, and erythema) of the fingers of both hands for a period of 1 1 or 2 2 days. She said she experienced by no means experienced such symptoms before and that they experienced only occurred following the injection of secukinumab. Inspection revealed RP in the fingers of both hands (Physique 1). In the control laboratory assessments, ESR: 13?mm/h and CRP: 1.5?mg/dl were detected. To explain the RP, other underlying pathologies were questioned and examined. Upon serological screening, rheumatoid factor, antinuclear antibody, extractable nuclear antigens, anticyclic citrullinated peptide antibody, antineutrophil cytoplasmic antibody,.