| New onset sarcoid-like granulomatosis developing during Anti-TNF therapy: an under-recognised complication. | |
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MedLine Citation:
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PMID: 21988678 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Introduction: Tumour necrosis factor-alpha [TNF-α] antagonists have advanced the treatment of inflammatory arthropathies, and even considered for use in refractory sarcoidosis with some success. Paradoxically, cases of new onset sarcoidosis-like diseases are increasingly reported in patients receiving TNF-α antagonists. Here, we report 3 cases of sarcoid-like granulomatosis that developed during treatment with TNF-α antagonists. Methods: Review of the Biologics clinic data base at Westmead identified 3 patients whom, during anti-TNF therapy, developed non-caseating granulomas consistent with sarcoidosis. These 3 cases are described with review of the literature from 2000 - 2009 using PubMed. Results: 169 patients within our data base were reviewed for the period 2003-2009. Sarcoidosis-like granulomas developed in 3 patients within a period of 3 to 36 months of treatment with etanercept and/or adalimumab. All cases demonstrated non-infective, non-caseating granulomas on renal or lymph node biopsy. Improvement was seen in 2 cases upon cessation of TNF-α antagonist and steroid therapy. Interestingly, clinical deterioration was noted upon re-challenge with the same TNF-α antagonist in 1 patient. To date, a total of 37 cases of sarcoid-like granuloma development after anti-TNF therapy have been reported in the literature. Conclusion: Development of sarcoidosis-like granulomatosis in patients treated with TNF-α antagonists is a phenomenon previously under-recognised. All 3 anti-TNF agents have been observed to cause this phenomenon, suggesting of a 'class effect' rather than being drug specific. |
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Authors:
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Denise Tong; Nicholas Manolios; Graydon Howe; David Spencer |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-10-12 |
Journal Detail:
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Title: Internal medicine journal Volume: - ISSN: 1445-5994 ISO Abbreviation: - Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-10-12 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101092952 Medline TA: Intern Med J Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© 2011 Sydney South West Area Health Service. Journal compilation © 2011 Royal Australasian College of Physicians. |
Affiliation:
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Department of Rheumatology, Westmead, Sydney. Australia. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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