| Vasculitis associated with tumor necrosis factor-α inhibitors. | |
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MedLine Citation:
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PMID: 22795634 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To describe the clinical characteristics, histopathologic features, and outcomes of patients in whom vasculitis developed in association with use of tumor necrosis factor-α (TNF-α) inhibitors. PATIENTS AND METHODS: This is a retrospective review of patients evaluated at Mayo Clinic, Rochester, Minnesota, from January 1, 1998, through March 31, 2011, with a diagnosis of vasculitis induced by anti-TNF-α therapy. RESULTS: Of 8 patients with vasculitis associated with anti-TNF-α therapy (mean age, 48.5 years), 6 (75%) were female. Four (50%) had rheumatoid arthritis, 1 (13%) had Crohn disease, and 3 (38%) had ulcerative colitis. Five (63%) were treated with infliximab, 2 (25%) with etanercept, and 1 (13%) with adalimumab. The mean duration of treatment before development of vasculitis was 34.5 months. The skin was the predominant organ affected (5 patients [63%]), with the most common cutaneous lesion being palpable purpura (4 of 5 [80%]). Two organs involved in systemic vasculitis were the peripheral nervous system (4 patients [50%]) and kidney (1 patient [13%]). All cases of vasculitis were histopathologically confirmed. Seven of 8 patients improved with discontinuation of therapy (mean time to resolution, 6.9 months) and adjuvant treatment (all 8 received prednisone; another agent was also used in 7); rechallenge with anti-TNF-α therapy was not attempted in any patient. At last follow-up, no patients had experienced a recurrence of vasculitis after therapy discontinuation. CONCLUSION: Cutaneous small-vessel vasculitis was the most common finding, but systemic vasculitis, including peripheral nerve and renal vasculitis, was also frequently observed. |
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Authors:
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Olayemi Sokumbi; David A Wetter; Ashima Makol; Kenneth J Warrington |
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Publication Detail:
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Type: Journal Article Date: 2012-07-13 |
Journal Detail:
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Title: Mayo Clinic proceedings. Mayo Clinic Volume: 87 ISSN: 1942-5546 ISO Abbreviation: Mayo Clin. Proc. Publication Date: 2012 Aug |
Date Detail:
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Created Date: 2012-08-06 Completed Date: 2012-10-24 Revised Date: 2013-04-08 |
Medline Journal Info:
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Nlm Unique ID: 0405543 Medline TA: Mayo Clin Proc Country: England |
Other Details:
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Languages: eng Pagination: 739-45 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Anti-Inflammatory Agents / adverse effects* Antibodies, Monoclonal / adverse effects* Antibodies, Monoclonal, Humanized / adverse effects Antibodies, Monoclonal, Murine-Derived / therapeutic use Arthritis, Rheumatoid / drug therapy Azathioprine / therapeutic use Colitis, Ulcerative / drug therapy Crohn Disease / drug therapy Cyclophosphamide / therapeutic use Female Glucocorticoids / therapeutic use Hematuria / etiology Humans Immunoglobulin G / adverse effects Immunologic Factors / therapeutic use Male Methotrexate / therapeutic use Middle Aged Mycophenolic Acid / analogs & derivatives, therapeutic use Polyneuropathies / etiology Prednisone / therapeutic use Proteinuria / etiology Receptors, Tumor Necrosis Factor Retrospective Studies Tumor Necrosis Factor-alpha / antagonists & inhibitors* Vasculitis / chemically induced*, drug therapy Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Anti-Inflammatory Agents; 0/Antibodies, Monoclonal; 0/Antibodies, Monoclonal, Humanized; 0/Antibodies, Monoclonal, Murine-Derived; 0/Glucocorticoids; 0/Immunoglobulin G; 0/Immunologic Factors; 0/Receptors, Tumor Necrosis Factor; 0/Tumor Necrosis Factor-alpha; 0/adalimumab; 0/infliximab; 0/rituximab; 128794-94-5/mycophenolate mofetil; 185243-69-0/TNFR-Fc fusion protein; 24280-93-1/Mycophenolic Acid; 446-86-6/Azathioprine; 50-18-0/Cyclophosphamide; 53-03-2/Prednisone; 59-05-2/Methotrexate |
| Comments/Corrections | |
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