Rheumatology Advance Access originally published online on May 7, 2009
Rheumatology 2009 48(8):883-886; doi:10.1093/rheumatology/kep046
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Sarcoid-like granulomatosis in patients treated with tumor necrosis factor blockers: 10 cases
1Service d’Immuno-Rhumatologie, CHU Lapeyronie, Montpellier, 2Hôpital La Pitié Salpétrière, 3Hôpital Henri Mondor, Paris, 4Hôpital Larrey, Toulouse, 5CHU Sébastopol, Reims, 6Hôpital Saint Philibert, Lomme, 7CHRU Hôpitaux de Tours, Tours, 8CHU Cochin, Paris, 9CHU de Bicêtre, Kremlin Bicêtre and 10CHU Jean Minjoz, Besançon, France.
Correspondence to: Jacques Morel, CHU Lapeyronie, Service d'Immuno-Rhumatologie, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier, France. E-mail: j-morel{at}chu-montpellier.fr
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Abstract |
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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 (
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.
KEY WORDS: Anti-TNF drugs, Granulomatosis, Sarcoidosis
Submitted 10 September 2008;
revised version accepted 6 February 2009.
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