Tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17) inhibitors are among the most potent treatments for inflammatory arthropathies including rheumatoid arthritis, psoriasis, and spondyloarthropathies. The availability of these biologic agents have revolutionized the management of these conditions and improved patient outcomes. Though generally safe, these biologics may contribute to the induction or exacerbation of colitis. This paradoxical colitis has been observed in patients on TNF-α inhibitor etanercept and IL-17 inhibitors (secukinumab and ixekizumab). We report a case of a 46-year-old female with psoriasis and psoriatic arthritis who presented with gastrointestinal symptoms after treatment with etanercept and IL-17 inhibitors. She was later diagnosed with paradoxical indeterminate colitis that was masked and treated by subsequent biologics given for her RA and psoriatic arthritis. In this report, we will discuss the importance of considering paradoxical colitis in the differential diagnosis for patients even several years after TNF-α/IL-17 inhibitor initiation and explain why careful consideration must be made when initiating these colitis-inducing agents to treat patients with inflammatory disorders.

肿瘤坏死因子-α (TNF-α) 和白介素 17 (IL-17) 抑制剂是治疗炎症性关节病（包括类风湿性关节炎、牛皮癣和脊柱关节病）最有效的药物之一。这些生物制剂的出现彻底改变了这些疾病的管理并改善了患者的治疗结果。虽然通常是安全的，但这些生物制剂可能会导致结肠炎的诱发或恶化。这种矛盾性结肠炎已在使用 TNF-α 抑制剂依那西普和 IL-17 抑制剂（苏金单抗和 ixekizumab）的患者中观察到。我们报道了一名患有银屑病和银屑病关节炎的 46 岁女性病例，她在接受依那西普和 IL-17 抑制剂治疗后出现胃肠道症状。后来她被诊断出患有矛盾性不确定性结肠炎，随后为她的 RA 和银屑病关节炎使用的生物制剂掩盖了这种症状并进行了治疗。在本报告中，我们将讨论在使用 TNF-α/IL-17 抑制剂数年后对患者进行鉴别诊断时考虑反常结肠炎的重要性，并解释为什么在开始使用这些结肠炎诱导剂治疗患者时必须仔细考虑患有炎症性疾病。