Journal List > J Korean Rheum Assoc > v.15(3) > 1003630

Han, Lee, Yoon, Choi, and Baek: Etanercept-related Cutaneous Nodulosis in a Patient with Rheumatoid Arthritis

Abstract

Etanercept is a recombinant human tumor necrosis factor (TNF) receptor fusion protein, which inhibits the biological activity of TNF-α. The common side effects of TNF-α inhibitors are injection site reactions, infusion reactions and infection. Rheumatoid nodules are the most common extraarticular manifestation of rheumatoid arthritis. Drugs such as methotrexate were reported to be associated with rheumatoid nodules, but etanercept-related nodules were uncommonly observed. We report the new formation of cutaneous rheumatoid nodules in a 58-year-old man during anti-TNFα therapy with etanercept. He had 2-year history of seropositive rheumatoid arthritis, and been treated with methotrexate, hydroxychloroquine, sulfasalazine, prednisolone and nonsteroidal anti-inflammatory drugs before etanercept regimen. Rheumatoid nodules developed on the palmar surface of fingers 4 month after treatment of etanercept, although his disease activity was maintained low. One month later, we decided to stop etanercept because his nodulosis extended to elbow. Since then, he has been followed up without any progression of rheumatoid nodules or aggravation of arthritis.

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Fig. 1.
0.5∼1 cm sized skin-colored 4 nodules on palmar surface of fingers.
jkra-15-250f1.tif
Fig. 2.
There is a fibrinoid degeneration of collagen surrounded by histiocytes in a palisaded arrangement (H&E stain, ×100).
jkra-15-250f2.tif
Table 1.
Reported cases of tumor necrosis factor inhibitors-related nodulosis in rheumatoid arthritis
Biologic agents Sex Age RF Pre-existent Nodules t New Nodules Time to Event (mo) Drug Withdrawal Outcome R Reference
Etanercept F 53 No Lung/SC 4 Yes Regression<2 ms 4
Etanercept M 52 SC SC 2 No Stable 5
Etanercept M 50 SC SC 3 No Stable 5
Etanercept M 67 No Lung 2 Yes Regression<3 ms 5
Etanercept F 41 SC Lung 21 Yes ? 6
Etanercept M 50 No Lung/SC 12 Yes Regression<3 ms 7
Etanercept M 58 No SC 4 Yes Stable Pr esent case
Infliximab F 44 SC SC 12 No ? 14
Adalimumab F 45 No SC 27 No Stable 15

RF: rheumatoid factor, SC: subcutaneous

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