Document Detail

New onset sarcoid-like granulomatosis developing during anti-TNF therapy: an under-recognised complication.
MedLine Citation:
PMID:  22389903     Owner:  NLM     Status:  MEDLINE    
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.
D Tong; N Manolios; G Howe; D Spencer
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Internal medicine journal     Volume:  42     ISSN:  1445-5994     ISO Abbreviation:  Intern Med J     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-03-02     Completed Date:  2012-06-01     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  89-94     Citation Subset:  IM    
Department of Rheumatology, Westmead Hospital, Sydney, New South Wales, Australia.
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MeSH Terms
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
Granuloma / chemically induced*,  pathology
Immunoglobulin G / adverse effects*
Kidney / pathology
Lymph Nodes / pathology
Middle Aged
Nephritis, Interstitial / chemically induced*,  pathology
Oceanic Ancestry Group
Receptors, Tumor Necrosis Factor
Sarcoidosis / chemically induced*,  pathology
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Reg. No./Substance:
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

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