title: Tumor necrosis factor inhibitor-associated dermatomyositis.
abstract: BACKGROUND
  Dermatomyositis is an autoimmune disease of unknown etiology characterized by inflammation of the skin and muscles. Several medications have been implicated in the development of dermatomyositis; however, the disease has rarely been linked to the use of tumor necrosis factor (TNF) inhibitors. We report 4 cases of dermatomyositis that developed or were exacerbated by exposure to the TNF inhibitors etanercept and adalimumab. Observation Four patients with symptoms of inflammatory arthritis were treated with TNF inhibitors for a duration ranging from 2 months to 2 years. All 4 patients developed symptoms consistent with dermatomyositis, including inflammatory rash and muscle weakness. Their symptoms persisted after discontinuation of the treatment with the TNF inhibitors but responded to treatment with corticosteroids and immunosuppressive medications.
  
  
  CONCLUSIONS
  Tumor necrosis factor inhibitors have been associated with the onset of a number of autoimmune disorders, most commonly vasculitis and a lupuslike syndrome. Rarely have they been associated with dermatomyositis. The 4 cases reported herein indicate that TNF inhibitor use can be associated with either induction or exacerbation of dermatomyositis.
authors.affiliation: Department of Medicine, Division of Rheumatology, University of Pennsylvania School of Medicine, Perelman Center for Advanced Medicine, First Floor South Pavilion, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Klein
authors.forename: Misha
authors.initials: M
authors.lastname: Rosenbach
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Kim
authors.forename: Brian
authors.initials: B
authors.lastname: Kim
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Werth
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dunham
mesh_terms: D000328:Adult; D015535:Arthritis, Psoriatic / Q000097:blood / Q000188:drug therapy / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy / Q000276:immunology; D015551:Autoimmunity / Q000187:drug effects*; D003882:Dermatomyositis / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology; D003937:Diagnosis, Differential; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000627:therapeutic use; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000097:blood
chemical_list: D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept