Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Rheumatology, etanercept, granuloma, infliximab, rheumatoid arthritis, sarcoidosis, TUMOR-NECROSIS-FACTOR, PULMONARY SARCOIDOSIS, INFLIXIMAB, INFECTION, RISK, Antibodies, Monoclonal, Antirheumatic Agents, Arthritis, Rheumatoid, Biopsy, Comorbidity, Etanercept, Female, Humans, Immunoglobulin G, Infliximab, Middle Aged, Receptors, Tumor Necrosis Factor, Remission Induction, Sarcoidosis, Treatment Outcome, Tumor Necrosis Factor-alpha, 1103 Clinical Sciences, Arthritis & Rheumatology, 3202 Clinical sciences, 3204 Immunology, 4201 Allied health and rehabilitation science

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.