Development of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association?

Hdl Handle:
http://hdl.handle.net/10147/198716
Title:
Development of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association?
Authors:
Haroon, Muhammad; Ryan, John G; Harney, Sinead
Affiliation:
Department of Rheumatology, Cork University Hospital, Cork, Ireland. mharoon301@hotmail.com
Citation:
Development of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association? 2011, 30 (8):1095-8 Clin. Rheumatol.
Publisher:
Springer
Journal:
Clinical rheumatology
Issue Date:
Aug-2011
URI:
http://hdl.handle.net/10147/198716
DOI:
10.1007/s10067-011-1704-7
PubMed ID:
21380931
Abstract:
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:
Article
Language:
en
Description:
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.
MeSH:
Anti-Inflammatory Agents, Non-Steroidal; Antibodies, 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
ISSN:
1434-9949

Full metadata record

DC FieldValue Language
dc.contributor.authorHaroon, Muhammaden
dc.contributor.authorRyan, John Gen
dc.contributor.authorHarney, Sineaden
dc.date.accessioned2011-12-22T15:05:05Z-
dc.date.available2011-12-22T15:05:05Z-
dc.date.issued2011-08-
dc.identifier.citationDevelopment of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association? 2011, 30 (8):1095-8 Clin. Rheumatol.en
dc.identifier.issn1434-9949-
dc.identifier.pmid21380931-
dc.identifier.doi10.1007/s10067-011-1704-7-
dc.identifier.urihttp://hdl.handle.net/10147/198716-
dc.descriptionThere 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.en
dc.description.abstractThere 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.-
dc.language.isoenen
dc.publisherSpringeren
dc.subject.meshAnti-Inflammatory Agents, Non-Steroidal-
dc.subject.meshAntibodies, Monoclonal, Murine-Derived-
dc.subject.meshAntirheumatic Agents-
dc.subject.meshArthritis, Rheumatoid-
dc.subject.meshDrug Therapy, Combination-
dc.subject.meshHumans-
dc.subject.meshImmunoconjugates-
dc.subject.meshImmunoglobulin G-
dc.subject.meshImmunosuppressive Agents-
dc.subject.meshMale-
dc.subject.meshMethotrexate-
dc.subject.meshMiddle Aged-
dc.subject.meshRadiography, Thoracic-
dc.subject.meshReceptors, Tumor Necrosis Factor-
dc.subject.meshSarcoidosis-
dc.subject.meshTreatment Outcome-
dc.titleDevelopment of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association?en
dc.typeArticleen
dc.contributor.departmentDepartment of Rheumatology, Cork University Hospital, Cork, Ireland. mharoon301@hotmail.comen
dc.identifier.journalClinical rheumatologyen
dc.description.provinceMunster-

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