Development of sarcoidosis in etanercept-treated rheumatoid arthritis patients

Clin Rheumatol. 2007 Nov;26(11):1969-71. doi: 10.1007/s10067-007-0594-1. Epub 2007 Mar 6.

Abstract

We report two rheumatoid arthritis patients developing sarcoidosis possibly induced by etanercept. Both women, aged 46 and 53, had erosive, rheumatoid-factor-positive rheumatoid arthritis (RA) for 7 and 6 years, respectively. The eldest had received infliximab for over a year with good response, which was stopped because of a perfusion reaction. She developed a cough and dyspnea after 6 months of etanercept treatment. The other developed erythema nodosum and a plaque lesion on the right arm after 1 year of etanercept. Imaging showed, in both cases, mediastinal adenopathies. Biopsies were compatible with sarcoidosis. Etanercept withdrawal led to a complete remission. Recently, there have been reports of noninfectious granulomatous syndromes in patients receiving etanercept for a variety of diseases. In our cases, the temporal association with etanercept therapy and the complete remission after suspension of etanercept suggest a triggering role of this agent. Possible mechanisms of action and supporting evidence are discussed.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal / adverse effects
  • Antirheumatic Agents / adverse effects*
  • Arthritis, Rheumatoid / complications*
  • Arthritis, Rheumatoid / drug therapy*
  • Biopsy
  • Comorbidity
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / adverse effects*
  • Infliximab
  • Middle Aged
  • Receptors, Tumor Necrosis Factor
  • Remission Induction
  • Sarcoidosis / chemically induced*
  • Sarcoidosis / diagnosis*
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors

Substances

  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Etanercept