Tohoku J. Exp. Med., 2022 February, 256(2)

Total Hip Joint Replacement in a Patient with Colchicine-Resistant Familial Mediterranean Fever under Canakinumab Treatment

Haruki Matsumoto,¹ Hironori Ohashi,² Yuya Fujita,¹ Shuhei Yoshida,¹ Kohei Yokose,¹ Jumpei Temmoku,¹ Naoki Matsuoka,¹ Yumetaka Shinden,³ Keigo Kusano,³ Tatsuru Sonobe,³ Yohei Nakamoto,⁴ Makiko Yashiro-Furuya,¹ Tomoyuki Asano,¹ Shuzo Sato,¹ Eiji Suzuki,⁵ Toru Yago,¹ Hiroshi Watanabe¹ and Kiyoshi Migita¹

¹Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
²Kaneko Clinic, Nishi shirakawa-gun, Fukushima, Japan
³Department of Orthopedics, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan
⁴Department of General Internal Medicine, Fukushima Medical University, Fukushima, Fukushima, Japan
⁵Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation, Koriyama, Fukushima, Japan

Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease characterized by recurrent episodes of fever and serositis. Periodic febrile attack can be managed with biologic medication in colchicine-resistant FMF patients, however, no reports or guidelines exist regarding the postoperative management of elective joint surgery in these patients. Although it is not clear how FMF attacks are triggered, they may be precipitated by stress including anesthesia or surgery. This study reports the case of a 51-year-old FMF patient who received total hip replacement under canakinumab (a specific interleukin-1β monoclonal antibody) treatment. He had highly active FMF, which was resistant to colchicine; however, his recurrent febrile attack with serositis was successfully controlled with canakinumab. Four months later from the start of canakinumab treatment, his hip osteoarthritis was required for total hip replacement (THR) because of the traumatic fracture. THR was successfully done and FMF attack was not occurred after this elective surgery. Discontinuation of canakinumab 3 weeks before surgery and resumption 6 weeks after led to favorable outcome without complications. This case addresses the differential management concerning stopping and restating of canakinumab in the perioperative setting in contrast to the other biologics such as tumor necrosis factor-α (TNF-α) or interleukin-6 (IL-6) blocking agents. This case report suggests that canakinumab may represent a safe and effective therapy for the colchicine-resistant FMF, even in the patients requiring THR therapy.

Keywords —— biologic; canakinumab; Familial Mediterranean fever; total hip replacement

© 2022 Tohoku University Medical Press

===============================

Tohoku J. Exp. Med 2022, 256, 169-174.

Correspondence:Kiyoshi Migita, M.D., Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan.

e-mail: migita@fmu.ac.jp