TY - JOUR T1 - Abrupt Development of Sarcoidosis with a Prodromal Increase in Plasma Osteopontin in a Patient with Rheumatoid Arthritis During Treatment with Etanercept JF - The Journal of Rheumatology JO - J Rheumatol SP - 210 LP - 211 DO - 10.3899/jrheum.090647 VL - 37 IS - 1 AU - SHINO TAKATORI AU - YASUYUKI KAMATA AU - TAKAMASA MUROSAKI AU - MASAHIRO IWAMOTO AU - SEIJI MINOTA Y1 - 2010/01/01 UR - http://www.jrheum.org/content/37/1/210.abstract N2 - To the Editor:Biologic disease-modifying antirheumatic drugs (DMARD) targeting tumor necrosis factor-α (TNF-α) are very efficacious and the number of patients with rheumatoid arthritis (RA) treated with these drugs is increasing rapidly. Because granulomatous diseases as typified by sarcoidosis are considered to develop in the Th1 cytokine milieu dominated by interferon-γ (IFN-γ) and TNF-α, anti-TNF-α agents have been used for treatment of sarcoidosis. Reports show that infliximab is effective, while etanercept is not, in the treatment of sarcoidosis1,2. In contrast, anti-TNF-α agents may have induced sarcoidosis in patients with RA and spondyloarthropathy3–6.The patient we describe had acute onset of sarcoidosis in several organs simultaneously after a long period of remission of RA while receiving etanercept. Based on serum and plasma levels of laboratory indicators related to sarcoidosis, the condition might have developed as quickly as within 1 or 2 months.A 52-year-old Japanese woman was diagnosed with RA in 1980 and had been treated with several DMARD such as injectable gold salt, sulfasalazine, actarit, methotrexate, and mizoribine with no appreciable effects. Leflunomide was started in … Address correspondence to Dr. S. Takatori, Division of Rheumatology and Clinical Immunology, Jichi Medical University, Yakushiji 3311-1, Shimotsuke-shi, Tochigi 329-0498, Japan. E-mail: stori{at}jichi.ac.jp ER -