| New onset sarcoid-like granulomatosis developing during anti-TNF therapy: an under-recognised complication. | |
MedLine Citation:
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PMID: 22389903 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Tumour necrosis factor-alpha (TNF-a) antagonists have advanced the treatment of inflammatory arthropathies, and are 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-a antagonists. Here, we report three cases of sarcoid-like granulomatosis that developed during treatment with TNF-a antagonists. Review of the Biologics clinic data base at Westmead, Sydney, Australia identified three patients whom, during anti-TNF therapy, developed non-caseating granulomas consistent with sarcoidosis. These three cases are described with review of the literature from 2000 to 2009 using PubMed. One hundred and sixty-nine patients within our data base were reviewed for the period 2003–2009. Sarcoidosis-like granulomas developed in three 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 two cases upon cessation of TNF-a antagonist and steroid therapy. Interestingly, clinical deterioration was noted upon re-challenge with the same TNF-a antagonist in one patient. To date, a total of 37 cases of sarcoid-like granuloma development after anti-TNF therapy have been reported in the literature. Development of sarcoidosis-like granulomatosis in patients treated with TNF-a antagonists is a phenomenon previously under-recognised. All three anti-TNF agents have been observed to cause this phenomenon, suggesting a ‘class effect’ rather than being drug specific. |
Authors:
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D Tong; N Manolios; G Howe; D Spencer |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Internal medicine journal Volume: 42 ISSN: 1445-5994 ISO Abbreviation: Intern Med J Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-03-02 Completed Date: 2012-06-01 Revised Date: 2013-05-27 |
Medline Journal Info:
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Nlm Unique ID: 101092952 Medline TA: Intern Med J Country: Australia |
Other Details:
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Languages: eng Pagination: 89-94 Citation Subset: IM |
Affiliation:
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Department of Rheumatology, Westmead Hospital, Sydney, New South Wales, Australia. dwytong@yahoo.com.au |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Antibodies, Monoclonal, Humanized / adverse effects* Antirheumatic Agents / adverse effects* Arthritis, Psoriatic / complications, drug therapy Arthritis, Rheumatoid / complications, drug therapy Australia / epidemiology European Continental Ancestry Group Female Granuloma / chemically induced*, pathology Humans Immunoglobulin G / adverse effects* Kidney / pathology Lymph Nodes / pathology Male Middle Aged Nephritis, Interstitial / chemically induced*, pathology Oceanic Ancestry Group Receptors, Tumor Necrosis Factor Recurrence Sarcoidosis / chemically induced*, pathology Tumor Necrosis Factor-alpha / antagonists & inhibitors* |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Monoclonal, Humanized; 0/Antirheumatic Agents; 0/Immunoglobulin G; 0/Receptors, Tumor Necrosis Factor; 0/Tumor Necrosis Factor-alpha; 185243-69-0/TNFR-Fc fusion protein; FYS6T7F842/adalimumab |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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