Teneligliptin-induced seronegative polyarthritis mimicking rheumatoid arthritis: A case report with positive rechallenge

Abstract:

Dipeptidyl peptidase-4 (DPP-4) inhibitors are established antidiabetic agents with generally favorable tolerability. Teneligliptin, a third-generation DPP-4 inhibitor widely used in South Asia, is valued for its cost-effectiveness and prolonged glycemic control. Arthralgia and drug-induced arthritis, though uncommon, have been recognized as potential adverse effects across this drug class. A 52-year-old male with newly diagnosed type 2 diabetes mellitus developed acute seronegative, nonerosive polyarthritis affecting bilateral wrists, ankles, knees, and metacarpophalangeal joints within 5 days of commencing teneligliptin 20 mg once a day. Autoimmune serological workup was negative; synovial fluid was sterile and crystal-free. Complete resolution followed drug withdrawal within 4 days. A subsequent rechallenge produced identical symptoms within 72 h, confirming a definite causal relationship (Naranjo score: 11). This case adds to the growing body of published reports of teneligliptin-induced polyarthritis and is notable for incorporating synovial fluid analysis and a prospective formal rechallenge. Awareness of this adverse effect is essential for clinicians initiating DPP-4 inhibitor therapy, particularly in regions where teneligliptin is widely prescribed.