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New onset sarcoid-like granulomatosis developing during Anti-TNF therapy: an under-recognised complication.
MedLine Citation:
PMID:  21988678     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Denise Tong; Nicholas Manolios; Graydon Howe; David Spencer
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-12
Journal Detail:
Title:  Internal medicine journal     Volume:  -     ISSN:  1445-5994     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 Sydney South West Area Health Service. Journal compilation © 2011 Royal Australasian College of Physicians.
Affiliation:
Department of Rheumatology, Westmead, Sydney. Australia.
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