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

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

J Korean Rheum Assoc 2008;15(3):250-254.

Published online: 20 September 2008

DOI: https://doi.org/10.4078/jkra.2008.15.3.250

Etanercept-related Cutaneous Nodulosis in a Patient with Rheumatoid Arthritis

Woo Jin Han1, Jong Rok Lee2, Kyu Hyun Yoon1, Hyo Jin Choi1, Han Joo Baek1

1Department of Internal Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea

2Department of Dermatology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea

Received 28 May 2008       Accepted 27 June 2008

Copyright © 2008 The Korean Rheumatism Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Tumor necrosis factor, Etanercept, Rheumatoid nodule

References

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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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