Original articleVasculitis Associated With Tumor Necrosis Factor-α Inhibitors
Section snippets
Patients and Methods
After approval by the Mayo Clinic Institutional Review Board, we searched the institutional medical index and text retrieval system to retrospectively identify patients who were evaluated at Mayo Clinic, Rochester, Minnesota, from January 1, 1998, through March 31, 2011, and who had a diagnosis of any form of vasculitis induced by anti–TNF-α therapy. We searched coded medical index data to identify patients with a diagnosis containing the terms vasculitis, Wegener's granulomatosis,
Results
The combined searches of the institutional medical index and text retrieval system yielded a preliminary cohort of 345 patients. Patients who did not meet the predefined inclusion criteria for this study were excluded (ie, evaluation was not compatible with vasculitis, patient was not receiving anti–TNF-α agent at the time vasculitis developed, underlying disease [eg, RA or IBD] was active at the time of vasculitis, or another more likely cause of vasculitis was found [eg, infection]), for a
Discussion
Anti–TNF-α therapy has been increasingly associated with drug-induced autoimmune diseases, such as cutaneous vasculitis, lupus-like syndrome, systemic lupus erythematosus, and interstitial lung disease.10, 13, 14, 15, 16 Vasculitis is the most common autoimmune disease that results from anti–TNF-α therapy.8, 9 To date, 213 cases of TNF-induced vasculitis have been reported in the medical literature: 39 in a nationwide series in France, 139 in Spain, and 35 in the United States that were derived
Conclusion
Anti–TNF-α therapy remains a valuable treatment for rheumatic and systemic autoimmune diseases. Although the risk of systemic vasculitis may be minimal, health care professionals should nonetheless be aware of, and should monitor for, this potential complication. If vasculitis associated with anti–TNF-α is suspected, histologic evaluation and extensive investigations for organ involvement must be pursued. The resolution of symptoms may be achieved by discontinuing use of the culprit anti–TNF-α
References (20)
- et al.
Cutaneous side effects of anti-tumor necrosis factor biologic therapy: a clinical review
J Am Acad Dermatol
(2009) - et al.
Paradoxical cutaneous manifestations during anti-TNF-alpha therapy [in French]
Ann Dermatol Venereol
(2010) - et al.
Autoimmune diseases induced by TNF-targeted therapies
Best Pract Res Clin Rheumatol
(2008) - et al.
Vasculitides induced by TNFα antagonists: a study in 39 patients in France
Joint Bone Spine
(2006) - et al.
Autoimmune diseases induced by biological agents: a double-edged sword?
Autoimmun Rev
(2010) - et al.
Lupus-like syndrome attributable to anti-tumor necrosis factor alpha therapy in 14 patients during an 8-year period at Mayo Clinic
Mayo Clin Proc
(2009) - et al.
Autoimmunity and anti-TNF-α agents
Ann N Y Acad Sci
(2005) - et al.
Tumor necrosis factor and anti-tumor necrosis factor therapies
J Rheumatol Suppl
(2010) Complications and adverse reactions in the use of newer biologic agents
Semin Cutan Med Surg
(2007)- et al.
Drug insight: autoimmune effects of medications: what's new?
Nat Clin Pract Rheumatol
(2008)
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