title: Musculoskeletal manifestations and autoimmune diseases related to new biologic agents.
abstract: OBJECTIVE
  The anti-tumor necrosis factor agents are now widely used in the management of patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile inflammatory arthritis. One of the most common observations made during their use is the development of autoantibodies. The purpose of this paper is to review this phenomenon and its clinical implications.
  
  
  RESULTS
  While the development of different autoantibodies is a common encounter, rare cases of lupus-like syndromes have been reported. On the other hand, a variety of immune-mediated clinical manifestations have been described, including vasculitis and demyelinating syndromes. Rare cases of cytopenia and non-specific lung injuries have also been reported.
  
  
  CONCLUSIONS
  While these clinical complications are rare and isolated events, clinicians must be aware of their occurrence. The experience with the anti-tumor necrosis factor agents is rather short and new, unusual immune-mediated complications may still appear. Clinicians should be prepared to recognize them.
authors.affiliation: Université de Montréal, RDU CHUM, Hôpital Notre-Dame, Montreal, Quebec, Canada. paulharaoui@attglobal.net
authors.forename: Boulos
authors.initials: B
authors.lastname: Haraoui
authors.forename: Edward
authors.initials: E
authors.lastname: Keystone
mesh_terms: D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001323:Autoantibodies / Q000276:immunology; D001327:Autoimmune Diseases / Q000276:immunology*; D001691:Biological Therapy / Q000009:adverse effects*; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects; D000069285:Infliximab; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced / Q000276:immunology; D009140:Musculoskeletal Diseases / Q000276:immunology*; D018124:Receptors, Tumor Necrosis Factor; D014657:Vasculitis / Q000139:chemically induced / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001323:Autoantibodies; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept