title: Tumor necrosis factor-alpha (TNF-α)-blockade-induced hepatic sarcoidosis in psoriatic arthritis (PsA): case report and review of the literature.
abstract: To study the cytokine profile in a 52 year old woman with psoriasis, PsA, and HCV who developed hepatic sarcoidosis following Etanercept therapy for 7 months. 11 PsA patients on TNF blockers mean disease duration 158.4 (SD 114.5), mean treatment duration 72.1 (SD 42.14) months, 8/11 PsA were on Etanercept and 5 healthy controls were studied. TNF-α, sTNF RI/RII, IFN-α/β/γ, IL-1 α, IL-15, IL-6, VEGF, s IL-1 R, sIL-6 R, IL-12, IL-23, IL-17, Adiponectin, Leptin and EGF were assessed. All PsA and controls tested negative for Quantiferon TB Gold, hepatitis B/C, HIV, ACE level, chest x-ray, liver function test (LFTs). Serologic biomarkers of the subject in comparison to the controls indicate that sTNF RI value was significantly higher; and IL-1 alpha level has a high outlier compared to the 11 PsA patients on TNF blockers. The clinical course, histologic findings, increased levels of s TNF R I and IL-1 α in the subject as compared to the other PsA on TNF blockade and controls, suggest that most likely Etanercept induced inflammatory cytokine imbalance was responsible for inducing hepatic sarcoidosis.
authors.affiliation: Medicine Department, Louisiana State University Health Sciences Center, New Orleans, LA, USA. rcucha@hotmail.com
authors.forename: Raquel
authors.initials: R
authors.lastname: Cuchacovich
authors.forename: Joseph
authors.initials: J
authors.lastname: Hagan
authors.forename: Tahir
authors.initials: T
authors.lastname: Khan
authors.forename: Arthur
authors.initials: A
authors.lastname: Richert
authors.forename: Luis R
authors.initials: LR
authors.lastname: Espinoza
mesh_terms: D015535:Arthritis, Psoriatic / Q000150:complications / Q000276:immunology*; D005260:Female; D006099:Granuloma / Q000150:complications / Q000276:immunology; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000276:immunology; D006801:Humans; D008099:Liver / Q000276:immunology*; D008107:Liver Diseases / Q000150:complications / Q000276:immunology*; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000276:immunology; D012507:Sarcoidosis / Q000150:complications / Q000276:immunology*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D019562:Viral Load
chemical_list: D014409:Tumor Necrosis Factor-alpha