title: Increased levels of rheumatoid factors after TNF inhibitor in rheumatoid arthritis.
abstract: Targeted inhibition of tumor necrosis factor-α (TNF-α) is an effective therapy in rheumatoid arthritis (RA). In some rare cases, autoimmune phenomena, including drug-induced lupus and vasculitis, is described. However, the immunological mechanisms underlying the development of autoimmunity are unknown. We report 3 patients that developed autoimmune phenomena while in use of TNF-α inhibitor, showing concomitant increase in rheumatoid factor (RF). We hypothesize that the increase in RF several months prior to the occurrence of vasculitis may help identifying other patients at risk for the development of vasculitis secondary to these medications.
authors.affiliation: Rheumatology Service, Pontifica Universidade de Campinas, Campinas, Brazil.
authors.forename: José Alexandre
authors.initials: JA
authors.lastname: Mendonça
authors.forename: João Francisco
authors.initials: JF
authors.lastname: Marques-Neto
authors.forename: Adil Muhib
authors.initials: AM
authors.lastname: Samara
authors.forename: Simone
authors.initials: S
authors.lastname: Appenzeller
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D015551:Autoimmunity / Q000276:immunology; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D000068800:Etanercept; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D008775:Methylprednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor; D012217:Rheumatoid Factor / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D012217:Rheumatoid Factor; D000068879:Adalimumab; D000068800:Etanercept; D011241:Prednisone; D008775:Methylprednisolone