Indolent infectious tenosynovitis afflicting rheumatoid patients treated with tumor necrosis factor inhibitors: case report.
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.
Abrams
Reid
R
Department of Orthopaedic Surgery, University of California, San Diego, School of Medicine, San Diego, CA 92103-8894, USA. raabrams@ucsd.edu
Savoia
Maria
M
Vinetz
Joseph
J
Dacus
A Rashard
AR
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*
D014409:Tumor Necrosis Factor-alpha