REVIEW - Sinus aspergilloma in RA before or during TNF-alpha antagonist therapy

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Arthritis Res Ther. 2009;11(6):R164. Epub 2009 Nov 3.

Sinus aspergilloma in rheumatoid arthritis before or during tumor

necrosis factor-alpha antagonist therapy.

Leboime A, Berthelot JM, Allanore Y, Khalil-Kallouche L, Herman P,

Orcel P, Lioté F.

Fédération de Rhumatologie, Pôle Appareil Locomoteur (centre Viggo

sen), Hôpital Lariboisière, Paris Diderot University, 2 rue

Ambroise Paré, Paris 75010, France.

Abstract

INTRODUCTION: In 2008, the Food and Drugs Administration required

manufacturers of TNFalpha antagonists to strengthen their warnings

about the risk of serious fungal infections in patients with

rheumatoid arthritis (RA). Sinus aspergilloma occurs occasionally in

RA patients and can progress to invasive Aspergillus disease. The

purpose of this study was to describe symptomatic sinus aspergilloma

in RA patients treated with TNFalpha antagonists.

METHODS: Retrospective descriptive study of symptomatic cases of sinus

aspergilloma in patients with RA followed in three French university

hospitals. A systematic literature review was performed.

RESULTS: Among 550 RA patients treated with TNFalpha antagonists, six

(1.1%) had symptomatic maxillary aspergilloma diagnosed by computed

tomography before or during TNFalpha antagonist therapy. None had

chronic neutropenia. Aspergilloma treatment was with surgery only in

all six patients. In the literature, we found 20 reports of

Aspergillus infection in patients with chronic inflammatory joint

diseases (including 10 with RA). Only 5/20 patients were treated with

TNFalpha antagonists (invasive lung aspergillosis, n = 3; intracranial

aspergillosis, n = 1; and sphenoidal sinusitis, n = 1).

CONCLUSIONS: Otorhinolaryngological symptoms must be evaluated before

starting or switching TNFalpha antagonists. Routine computed

tomography of the sinuses before starting or switching TNFalpha

antagonists may deserve consideration.

PMID: 19886992

http://www.ncbi.nlm.nih.gov/pubmed/19886992

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