title: Acquired hemophilia possibly induced by etanercept in a patient with rheumatoid arthritis.
abstract: A 47-year-old woman with rheumatoid arthritis (RA) treated successively with infliximab, abatacept, and etanercept spontaneously developed subcutaneous bruises and a noncompressive hematoma 11 months after starting etanercept therapy (50mg/week). Her prothrombin time was normal but her activated partial thromboplastin time was increased to 2.48 (normal range, 0.85-1.17). She had a circulating anticoagulant (Rosner index, 45; normal,<13) due to an anti-factor VIII antibody in a titer of 45 Bethesda units. Her factor VIII level was less than 1% (normal range, 55-150). The etanercept and leflunomide were stopped and prednisone was given in a daily dosage of 1mg/kg, in combination with rituximab, two 1-g doses at an interval of 2 weeks. After 5 months, persistence of the anti-factor VIII antibody prompted the initiation of azathioprine therapy, 2mg/kg/d. A remission was achieved 9 months after the diagnosis of acquired hemophilia and was sustained at last follow-up after 3 years. This new case of acquired hemophilia in a patient with RA may reflect a simple association or an inducing role of etanercept.
authors.affiliation: Service de rhumatologie, CHU-Hôpitaux de Rouen, Inserm U905, CRB CIC 1404, IRIB, Université de Rouen, 76031 Rouen Cedex, France. Electronic address: totobanse@orange.fr.
authors.forename: Christopher
authors.initials: C
authors.lastname: Banse
authors.affiliation: Service de Médecine Interne, CHU-Hôpitaux de Rouen, Inserm U1096, IRIB, Université de Rouen, 76031 Rouen Cedex, France.
authors.forename: Ygal
authors.initials: Y
authors.lastname: Benhamou
authors.affiliation: Service de rhumatologie, CHU-Hôpitaux de Rouen, Inserm U905, CRB CIC 1404, IRIB, Université de Rouen, 76031 Rouen Cedex, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lequerré
authors.affiliation: Unité d'Hémostase, CHU-Hôpitaux de Rouen, Inserm U1096, IRIB, Université de Rouen, 76031 Rouen Cedex, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Le Cam-Duchez
authors.affiliation: Service de Médecine Interne, CHU-Hôpitaux de Rouen, Inserm U1096, IRIB, Université de Rouen, 76031 Rouen Cedex, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Lévesque
authors.affiliation: Service de rhumatologie, CHU-Hôpitaux de Rouen, Inserm U905, CRB CIC 1404, IRIB, Université de Rouen, 76031 Rouen Cedex, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Vittecoq
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D000068800:Etanercept / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006467:Hemophilia A / Q000139:chemically induced*; D006801:Humans; D008875:Middle Aged
chemical_list: D018501:Antirheumatic Agents; D000068800:Etanercept
keywords: Acquired hemophilia; Etanercept; Rheumatoid arthritis