Clinical Rheumatology

, Volume 26, Issue 11, pp 1969–1971

Development of sarcoidosis in etanercept-treated rheumatoid arthritis patients

  • Kilian Verschueren
  • Els Van Essche
  • Patrick Verschueren
  • Veerle Taelman
  • Rene Westhovens
Case Report


We report two rheumatoid arthritis patients developing sarcoidosis possibly induced by etanercept. Both women, aged 46 and 53, had erosive, rheumatoid-factor-positive rheumatoid arthritis (RA) for 7 and 6 years, respectively. The eldest had received infliximab for over a year with good response, which was stopped because of a perfusion reaction. She developed a cough and dyspnea after 6 months of etanercept treatment. The other developed erythema nodosum and a plaque lesion on the right arm after 1 year of etanercept. Imaging showed, in both cases, mediastinal adenopathies. Biopsies were compatible with sarcoidosis. Etanercept withdrawal led to a complete remission. Recently, there have been reports of noninfectious granulomatous syndromes in patients receiving etanercept for a variety of diseases. In our cases, the temporal association with etanercept therapy and the complete remission after suspension of etanercept suggest a triggering role of this agent. Possible mechanisms of action and supporting evidence are discussed.


Etanercept Granuloma Infliximab Rheumatoid arthritis Sarcoidosis 


  1. 1.
    Haraoui B (2005) Differentiating the efficacy of the tumor necrosis factor inhibitors. Semin Arthritis Rheum 34(Suppl 1):7–11PubMedCrossRefGoogle Scholar
  2. 2.
    Wallis RS, Ehlers S (2005) Tumor necrosis factor and granuloma biology: explaining the differential infection risk of etanercept and infliximab. Semin Arthritis Rheum 34(5 Suppl1):34–38PubMedCrossRefGoogle Scholar
  3. 3.
    Furst DE, Wallis R, Broder M et al (2006) Tumor necrosis factor antagonists: different kinetics and/or mechanisms of action may explain differences in the risk for developing granulomatous infection. Semin Arthritis Rheum 36(3):159–167PubMedCrossRefGoogle Scholar
  4. 4.
    Gonzalez-Lopez MA, Blanco R, Gonzalez-Vela MC et al (2006) Development of sarcoidosis during etanercept therapy. Arthritis Rheum 55(5):817–820PubMedCrossRefGoogle Scholar
  5. 5.
    Nunes H, Soler P, Valeyre D (2005) Pulmonary sarcoidosis. Allergy 60(5):565–582PubMedCrossRefGoogle Scholar
  6. 6.
    Ziegenhagen MW, Muller-Quernheim J (2003) The cytokine network in sarcoidosis and its clinical relevance. J Intern Med 253:18–30PubMedCrossRefGoogle Scholar
  7. 7.
    Keystone EC (2004) The utility of tumour necrosis factor blockade in orphan diseases. Ann Rheum Dis 63(Suppl 2):ii79–ii83PubMedCrossRefGoogle Scholar
  8. 8.
    Doty JD, Mazur JE, Judson MA (2005) Treatment of sarcoidosis with infliximab. Chest 127:1064–1071PubMedCrossRefGoogle Scholar
  9. 9.
    Utz JP, Limper AH, Kalra S et al (2003) Etanercept for the treatment of stage II and III progressive pulmonary sarcoidosis. Chest 124:177–185PubMedCrossRefGoogle Scholar
  10. 10.
    Kucera RF (1989) A possible association of rheumatoid arthritis and sarcoidosis. Chest 95(3):604–606PubMedGoogle Scholar
  11. 11.
    Dinarello CA (2005) Differences between anti-tumor necrosis factor-α monoclonal antibodies and soluble TNF receptors in host defense impairment. J Rheumatol Suppl 74:40–47PubMedGoogle Scholar

Copyright information

© Clinical Rheumatology 2007

Authors and Affiliations

  • Kilian Verschueren
    • 1
  • Els Van Essche
    • 2
  • Patrick Verschueren
    • 1
  • Veerle Taelman
    • 1
  • Rene Westhovens
    • 1
    • 3
  1. 1.Department of Rheumatology, University Hospitals LeuvenKatholieke Universiteit LeuvenLeuvenBelgium
  2. 2.Rheumatology MolMolBelgium
  3. 3.Universitair Ziekenhuis LeuvenLeuvenBelgium

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