TNF-alpha Antagonists Induce Lupus-Like Syndrome in Patients with Scleroderma and Polyarthritis

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TNF-alpha Antagonists Induce Lupus-Like Syndrome in Patients with

Scleroderma and Polyarthritis

Category: 20 Scleroderma, fibrosing syndromes

, Fredrick Wigley

s Hopkins University, Baltimore, MD

Presentation Number: 915

Poster Board Number: 380

Keywords: Scleroderma, Lupus-Like Syndrome, TNF-alpha Antagonists

Background Novel biologic agents, that attenuate

inflammation by targeting TNF alpha, have gained acceptance in the

treatment of rheumatoid arthritis and other inflammatory joint diseases.

Recent case reports suggest that etanercept or infliximab can induce a

lupus-like syndrome and/or lupus related auto-antibodies. We report two

cases of patients with scleroderma and a rheumatoid-like polyarthritis

who failed traditional anti-inflammatory therapies. Both developed

clinical and serological parameters consistent with a lupus-like

syndrome following the use of etanercept or infliximab.

Objective This is the first report of the development of

lupus-like syndromes in patients with a scleroderma overlap syndrome

following treatment with TNF alpha antagonists.

Population and Study Design Two case reports illustrate the

clinical characteristics and serological parameters of each patient

before and after the initiation of anti- TNF alpha therapy.

Both patients developed clinical features and serological

markers consistent with a lupus-like syndrome. Discontinuation of the

therapies produced clinical remission in both cases, and re-challenge

with infliximab in the second case precipitated the recurrence of the

lupus-like syndrome.

Conclusions: Etanercept and Infliximab have gained

increasing popularity as therapeutic options in rheumatoid arthritis and

other inflammatory joint diseases. Our patients both had an overlap

syndrome with prominent rheumatoid-like polyarthritis not responsive to

the traditional therapeutic agents such as methotrexate, azathioprine,

and corticosteroids. Although TNF alpha antagonists are not specifically

contraindicated in overlap syndromes, we suggest caution when using

these agents in this patient population. Our patients initially

presented with overlap syndromes with features of scleroderma and

rheumatoid arthritis. Clinicians should be aware of the development of a

lupus-like syndrome in patients who have mixed connective tissue disease

or scleroderma with overlap syndromes when treated with these new

biologic agents.