Case Report

Anti-Tumor Necrosis Factor-a Therapy-Induced Vasculitis: Case Series

STEPHEN J. JARRETT, GAYE CUNNANE, PHILIP G. CONAGHAN, SARAH J. BINGHAM, MAYA H. BUCH, MARK A. QUINN, and PAUL EMERY

ABSTRACT.

As experience with anti-tumor necrosis factor (TNF-a) therapy increases, there has been the expected emergence of reports on uncommon side effects. Large clinical trials identified the development of autoantibodies and postmarketing surveillance has identified problems including tuberculosis. There have been several case reports of drug-induced systemic lupus erythematosus. We describe 8 patients with rheumatoid arthritis treated with anti-TNF therapies who developed presumed vasculitis, with different pathophysiologic causes. We discuss the literature and potential causal mechanisms, including disease activity, the role of autoantibodies, and shifts in T cell responses. (J Rheumatol 2003;30:2287-91)

Key Indexing Terms:

ETANERCEPT
INFLIXIMAB
VASCULITIS
RHEUMATOID ARTHRITIS

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From the Academic Unit of Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.

S.J. Jarrett, BSc, MRCP, Research Fellow; G. Cunnane, PhD, MRCPI, Senior Lecturer in Rheumatology; P.G. Conaghan, MBBS, FRACP, Senior Lecturer in Rheumatology; S.J. Bingham, MA, MRCP, Research Fellow; M.H. Buch, MRCP, Research Fellow; M.A. Quinn, MBChB, MRCP, Lecturer in Rheumatology; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology and Lead Clinician, University of Leeds.

Address reprint requests to Prof. P. Emery, Academic Unit of Musculoskeletal Medicine, University of Leeds, Great George Street, Leeds, LS1 3EX, United Kingdom. E-mail: p.emery@leeds.ac.uk

Submitted December 6, 2002; revision accepted February 21, 2003.

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