title: Priapism after tumor necrosis factor alpha inhibitor use.
abstract: We present a possible important association of tumor necrosis factor-alpha inhibition (TNFa-i) and erectile function in a male patient with rheumatoid arthritis (RA). Long-standing, untreated RA may result in significant physical limitation and disability, however often overlooked is the association between RA and erectile and sexual dysfunction. Ischemic priapism is currently unrecognized as an adverse reaction associated with TNFa-i use and there have been no reported cases with adalimumab. Our patient, a 58-year-old Hispanic man, with sero-positive, erosive RA developed persistent priapism (17 days) despite multiple urologic interventions after initial adalimumab 40 mg administration. TNFa has recently been implicated as a potential factor in erectile dysfunction through its role in vascular reactivity. Excess TNFa, from active RA, may perturb intracavernosal smooth muscle and endothelial cell function; theoretically, TNFa inhibition may then causes excess local nitric oxide production and subsequent priapism. The potential role of TNFa-i in ED and risk for priapism is an important area for future study.
authors.affiliation: Division of Rheumatology, Department of Medicine, Keck School of Medicine at University of Southern California, Hoffman Medical Research Center, 2011 Zonal Ave, HMR 711, Los Angeles, CA, 90033, USA, ajk_001@usc.edu.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Kreitenberg
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Ortiz
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Arkfeld
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D010413:Penis / Q000187:drug effects; D011317:Priapism / Q000139:chemically induced* / Q000208:ethnology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D009569:Nitric Oxide; D000068879:Adalimumab