Development of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association?
Affiliation
Department of Rheumatology, Cork University Hospital, Cork, Ireland. mharoon301@hotmail.comIssue Date
2011-08MeSH
Anti-Inflammatory Agents, Non-SteroidalAntibodies, Monoclonal, Murine-Derived
Antirheumatic Agents
Arthritis, Rheumatoid
Drug Therapy, Combination
Humans
Immunoconjugates
Immunoglobulin G
Immunosuppressive Agents
Male
Methotrexate
Middle Aged
Radiography, Thoracic
Receptors, Tumor Necrosis Factor
Sarcoidosis
Treatment Outcome
Metadata
Show full item recordCitation
Development of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association? 2011, 30 (8):1095-8 Clin. Rheumatol.Publisher
SpringerJournal
Clinical rheumatologyDOI
10.1007/s10067-011-1704-7PubMed ID
21380931Abstract
There have been numerous reports of granulomatous diseases developing in patients receiving anti-tumour necrosis factor (TNF) therapy. Herein, we report a patient who developed sarcoidosis 6 months after discontinuation of etanercept. To date, all reported cases have occurred in patients undergoing ongoing treatment with TNF blockers with resolution on its discontinuation. A 47-year-old man was diagnosed with seropositive rheumatoid arthritis (RA) in 2003. He was initially treated with methotrexate and corticosteroids. In 2005, adalimumab was added due to ongoing disease activity. However, he had persistent low-grade synovitis of bilateral wrist joints and remained oral glucocorticoids dependent. In October 2008, adalimumab was switched to etanercept with marginal benefit; however, etanercept was continued until March 2009. Rituximab was discontinued due to an immediate allergic reaction. In September 2009, he developed bilateral ankle synovitis with erythema nodosum. Further investigations (chest X-ray and CT scan of thorax) revealed new development of bilateral hilar lymphadenopathy and interstitial nodular changes typical of sarcoidosis. His baseline therapy of methotrexate was continued. His recent repeat chest X-ray and CT scan of thorax (March 2010) has shown significant spontaneous resolution of his mediastinal lymphadenopathy and pulmonary nodules. Apart from the initial brief course of NSAIDs, his sarcoidosis resolved spontaneously without requiring any further therapy. For his rheumatoid arthritis, he has been recently commenced on abatacept and his baseline therapy of methotrexate has been continued. It remains speculative as to whether the concurrence of RA and sarcoidosis is purely serendipitous, or is related to an immunodysregulatory state attributable to TNF blockade.Item Type
ArticleLanguage
enISSN
1434-9949ae974a485f413a2113503eed53cd6c53
10.1007/s10067-011-1704-7
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