RESEARCH - Sarcoid-like granulomatosis in patients treated with TNF blockers: 10 cases

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Rheumatology Advance Access published online on May 7, 2009

Rheumatology, doi:10.1093/rheumatology/kep046

Sarcoid-like granulomatosis in patients treated with tumor necrosis

factor blockers: 10 cases

Immediato Daïen1, Agnes Monnier2, Pascal Claudepierre3, Arnaud

Constantin4, Jean- Eschard5, Houvenagel6, Mahtab Samimi7,

Stephan Pavy8, Edouard Pertuiset9, Toussirot10, Bernard Combe1,

Jacques Morel1 and for the Club Rhumatismes et Inflammation (CRI)

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 Minjoz, Besançon, France

Abstract

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.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep046v1?papetoc

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