title: Indolent infectious tenosynovitis afflicting rheumatoid patients treated with tumor necrosis factor inhibitors: case report.
abstract: Tumor necrosis factor (TNF) is a cytokine associated with the pathogenesis of rheumatoid arthritis. Tumor necrosis factor inhibitors have become important biological treatments that favorably alter the natural history of rheumatoid disease. Side effects include an increased risk of malignancy and infection, particularly tuberculosis. We present 2 patients with rheumatoid arthritis on TNF inhibitors in whom flares of wrist tenosynovitis, initially diagnosed as rheumatoid disease exacerbations, were caused by infections with uncommon opportunistic pathogens. Diagnostic and treatment recommendations for this subset of rheumatoid patients are discussed.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Diego, School of Medicine, San Diego, CA 92103-8894, USA. raabrams@ucsd.edu
authors.forename: Reid
authors.initials: R
authors.lastname: Abrams
authors.forename: Maria
authors.initials: M
authors.lastname: Savoia
authors.forename: Joseph
authors.initials: J
authors.lastname: Vinetz
authors.forename: A Rashard
authors.initials: AR
authors.lastname: Dacus
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D003646:Debridement; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000150:complications*; D009894:Opportunistic Infections / Q000150:complications*; D020127:Recovery of Function; D013709:Tendon Transfer; D013717:Tenosynovitis / Q000150:complications* / Q000382:microbiology* / Q000601:surgery; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014955:Wrist Joint / Q000382:microbiology*
chemical_list: D014409:Tumor Necrosis Factor-alpha