RESEARCH - Granuloma annulare induced by anti-TNF therapy

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Ann Rheum Dis. 2008 Apr;67(4):567-70. Epub 2007 Aug 29.

Granuloma annulare induced by anti-tumour necrosis factor therapy.

Voulgari PV, Markatseli TE, Exarchou SA, Zioga A, Drosos AA.

Rheumatology Clinic, Department of Internal Medicine, Medical School,

University of Ioannina, Ioannina, Greece.

OBJECTIVE: To describe granuloma annulare (GA) skin lesion development

in patients during anti-tumour necrosis factor (TNF) therapy. METHODS:

199 patients with rheumatoid arthritis and 127 suffering from

spondyloarthropathies treated with anti-TNF antagonists were analysed

to identify skin lesions suggesting GA. RESULTS: Nine cases of GA

during anti-TNF therapy (123 treated with infliximab, 57 with

adalimumab and 17 with etanercept) for rheumatoid arthritis were

identified. Two have been treated with infliximab, six with adalimumab

and one with etanercept, and here the development of GA was 4.5%. No

patient with spondyloarthropathies developed such skin lesions. All

patients developed the generalised form of GA. None had or developed

diseases, or conditions known to be associated with GA. In seven

patients the skin eruptions developed during the first year of

anti-TNF treatment, while they developed in two patients during the

second year. Two patients had to stop anti-TNF therapy due to the

extent of skin lesions. All patients responded well to the local

corticosteroid therapy.

CONCLUSIONS: Our series strongly supports a link between TNF

inhibition and the development of GA in some patients. When dealing

with patients on these agents physicians should be aware of possible

adverse events and the potential development of such complications.

PMID: 17728330 [PubMed - in

http://www.ncbi.nlm.nih.gov/pubmed/17728330

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