title: HTLV-1-associated arthropathy treated with anti-TNF-alpha agent.
abstract: Human T cell leukemia virus type 1 or HTLV-1 infection is a public health problem in endemic regions like Japan, Central America or Africa. Although the majority of HTLV-1 carriers remain asymptomatic throughout their lives, some patients could develop neurological disorder, inflammatory arthropathy also called HTLV-1-associated arthropathy or T-cell malignancy, the adult T-cell leukemia/lymphoma or ATL with a very poor prognosis. Described to be very close to rheumatoid arthritis, HTLV-1-associated arthropathy patients have few or no response to the first line therapy with corticosteroids and disease modifying antirheumatic drugs or DMARDs. The use of anti-TNF-α agents in these patients is an interesting alternative but asks the question of risk of developing an adult T-Cell leukemia/lymphoma. We reported an exceptional case of a smoldering ATL patient with an HTLV-1-associated arthropathy, refractory to corticosteroid, DMARDs and rituximab therapy, treated successfully with etanercept, without progression to aggressive ATL after 5 years.
authors.affiliation: Service d'hématologie adulte, centre de référence des mastocytoses, CNRS UMR 8147, institut Imagine, hôpital Necker Enfant Malade, 75015 Paris, France. Electronic address: laurent.frenzel@nck.aphp.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Frenzel
authors.affiliation: 5, Square du Roule, 75008 Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Moura
authors.affiliation: Service d'hématologie adulte, centre de référence des mastocytoses, CNRS UMR 8147, institut Imagine, hôpital Necker Enfant Malade, 75015 Paris, France.
authors.forename: Ambroise
authors.initials: A
authors.lastname: Marcais
authors.affiliation: Service d'immunologie et allergologie, centre hospitalier universitaire de Montréal, 1560, rue Sherbrooke, H2L 4M1 Montreal, Canada.
authors.forename: Hugo
authors.initials: H
authors.lastname: Chapdelaine
authors.affiliation: Service d'hématologie adulte, centre de référence des mastocytoses, CNRS UMR 8147, institut Imagine, hôpital Necker Enfant Malade, 75015 Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hermine
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000821:virology; D000068800:Etanercept; D005260:Female; D015368:Human T-lymphotropic virus 1; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D008875:Middle Aged; D011859:Radiography; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept
keywords: Anti-TNF-alpha; HTLV-1; HTLV-1-associated-arthropathy (HAAP); T-cell lymphoma