Rheumatology

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Sarcoid-like granulomatosis in patients treated with tumor necrosis factor blockers: 10 cases
Rheumatology, 05/11/09

Daïen CI et al. – Sarcoid-like granulomatosis is rare but not exceptional in patients treated with TNF blockers and does not seem to be related to gender, rheumatic disease or the type of anti-TNF drug used (monoclonal antibodies or soluble receptor). Discontinuation of anti-TNF usually leads to recovery.

• Study reports a series of sarcoid-like granulomatosis following TNF blocker treatment
• 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

• 10 pts; 7 females, median age 50.5 yrs, with sarcoid-like granulomatosis while on anti-TNF treatment:
  • 5 were treated with etanercept and 5 with monoclonal Abs
  • 4 pts received TNF blockers for RA and 6 for SpA
  • Median delay between anti-TNF agent introduction and granulomatosis diagnosis was 18 mo
  • Clinical symptoms were mainly pulmonary and cutaneous
  • Angiotensin-converting enzyme activity was increased in 6 cases
  • Lymph-node and/or lung involvement were observed for 8 pts
• Median delay between drug discontinuation and remission was 6 mo for clinical signs and 6 mo for biological and radiographic findings
• Improvement was observed in all pts after drug discontinuation with or w/o steroids

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