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著者: Claire Immediato Daïen, Agnes Monnier, Pascal Claudepierre, Arnaud Constantin, Jean-Paul Eschard, Eric Houvenagel, Mahtab Samimi, Stephan Pavy, Edouard Pertuiset, Eric Toussirot, Bernard Combe, Jacques Morel, Club Rhumatismes et Inflammation (CRI)
雑誌名: Rheumatology (Oxford). 2009 Aug;48(8):883-6. doi: 10.1093/rheumatology/kep046. Epub 2009 May 7.
Abstract/Text
OBJECTIVE: TNF blockers have been recently evaluated for treating refractory sarcoidosis and could be efficient. However, several cases of sarcoidosis have been diagnosed during anti-TNF therapy. Here, we report the largest series of sarcoid-like granulomatosis following TNF blocker treatment.
METHODS: A call for observations of sarcoid-like granulomatosis following TNF blocker treatment was sent to the members of the French 'Club Rhumatismes et Inflammation'. Histological evidence of granulomatosis was required.
RESULTS: Observations of 10 patients [seven females; median age 50.5 (range 27-72) years] with sarcoid-like granulomatosis while on anti-TNF treatment were collected: five were treated with etanercept and five with monoclonal antibodies; four patients received TNF blockers for RA and six for SpA. The median delay between anti-TNF agent introduction and granulomatosis diagnosis was 18 (range 1-51) months. Clinical symptoms were mainly pulmonary and cutaneous. Angiotensin-converting enzyme activity was increased in six cases. Lymph-node and/or lung involvement were observed by CT scan of the chest for eight patients. The median delay between drug discontinuation and remission was 6 (range 1-11) months for clinical signs and 6 (range 2-12) months for biological and radiographic findings. Improvement was observed in all patients after drug discontinuation with or without steroids.
CONCLUSIONS: Sarcoid-like granulomatosis is rare but not exceptional in patients treated with TNF blockers (approximately 1/2800) and does not seem to be related to gender, rheumatic disease or in our series the type of anti-TNF drug used (monoclonal antibodies or soluble receptor). Discontinuation of anti-TNF usually leads to recovery.
PMID 19423648 Rheumatology (Oxford). 2009 Aug;48(8):883-6. doi: 10.1093/rheumatology/kep046. Epub 2009 May 7.
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