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Sinus aspergilloma in rheumatoid arthritis before or during tumor necrosis factor-alpha antagonist therapy
Arthritis Research & Therapy, 11/10/09

Leboime A et al. – Otorhinolaryngological symptoms must be evaluated before starting or switching TNF-alpha antagonists. Routine computed tomography of the sinuses before starting or switching TNF-alpha antagonists may deserve consideration.

Methods

Retrospective descriptive study of symptomatic cases of sinus aspergilloma in patients with RA followed in three French university hospitals
Systematic literature review performed

Results

550 RA patients treated with TNF-alpha antagonists, 6 (1.1%) had symptomatic maxillary aspergilloma diagnosed by computed tomography before or during TNF-alpha antagonist therapy
None had chronic neutropenia
Aspergilloma treatment was with surgery only in all 6 patients
20 reports of Aspergillus infection in patients with chronic inflammatory joint diseases (including 10 with RA)
Only 5/20 patients were treated with TNF-alpha antagonists (invasive lung aspergillosis, n=3; intracranial aspergillosis, n=1; and sphenoidal sinusitis, n=1)

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