title: Development of sarcoidosis in etanercept-treated rheumatoid arthritis patients.
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.
authors.affiliation: Department of Rheumatology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium. rene.westhovens@uz.kuleuven.ac.be
authors.forename: Kilian
authors.initials: K
authors.lastname: Verschueren
authors.forename: Els
authors.initials: E
authors.lastname: Van Essche
authors.forename: Patrick
authors.initials: P
authors.lastname: Verschueren
authors.forename: Veerle
authors.initials: V
authors.lastname: Taelman
authors.forename: Rene
authors.initials: R
authors.lastname: Westhovens
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy*; D001706:Biopsy; D015897:Comorbidity; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D000069285:Infliximab; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor; D012074:Remission Induction; D012507:Sarcoidosis / Q000139:chemically induced* / Q000175:diagnosis*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept