Rituximab for Rheumatoid Arthritis Following TNF-alpha Inhibitor Associated Splenic Tuberculosis

One of the most important adverse effects of a tumor necrosis factor (TNF)-alpha inhibitor is the reactivation of tuberculosis. Most of them occur in the lung, but sometimes they can be found in other organs. Moreover, the proper management of active rheumatoid arthritis (RA) in patients with anti-TNF-alpha associated tuberculosis is still in debate. We present the case of a seropositive RA patient who showed good response with rituximab, an anti-CD20 monoclonal antibody, after developing splenic tuberuculosis, following treatment with TNF-alpha inhibitor. Confirming a diagnosis of splenic tuberculosis is difficult and can be delayed due to its nonspecific symptoms and rare occurrence. This case suggests that splenic tuberculosis should be doubted in RA patients treated with TNF-alpha inhibitor, and that rituximab may be considered as an alternative treatment option in RA patients with anti-TNF-alpha associated tuberculosis.

Secondary Amyloidosis Development in a Patient with Juvenile Rheumatoid Arthritis on TNF-alpha Inhibitors Treatment

Secondary amyloidosis is one of the most serious complications in chronic inflammatory diseases such as rheumatoid arthritis. The extracellular deposit of aggregates of amyloid leads to target organ dysfunction. The mainstay treatment of secondary amyloidosis is the control of underlying disease activity. Many reports have reported that TNF-alpha inhibitors improve clinical outcomes. Here, we encountered a 34-year-old patient with juvenile rheumatoid arthritis who developed secondary amyloidosis despite treatment with TNF-alpha inhibitors. We present this case and include a review of the literature.

A Case of Pustular Psoriasis Developed during Infliximab Treatment for Crohn's Disease / 대한피부과학회지

Infliximab is a monoclonal antibody that binds and inactivates tumor necrosis factor-alpha. It has been successfully used to manage diseases associated with a Th1 profile such as psoriasis, Crohn's disease, and rheumatoid arthritis. A 15-year-old boy presented for erythematous scaly papules and pustules with crust on his entire body, which had appeared initially 2 months ago. He had been treated with infliximab for Crohn's disease during the last 14 months and had not been diagnosed with psoriasis. A skin biopsy specimen demonstrated papulosquamous dermatitis with subcorneal pustule formation, suggestive of pustular psoriasis. The patient was treated with oral retinoid 20 mg/d for 3 weeks and 10 mg/d for next 3 weeks with concurrent topical steroid, and most lesions disappeared completely with post inflammatory hyperpigmentation. No evidence of recurrence has been observed during 3 months of followup.

Granuloma Annulare Induced by Adalimumab / 대한피부과학회지

Adalimumab is the first fully humanized monoclonal anti-tumor necrosis factor alpha (TNF-alpha) antibody. This drug has been shown to be of benefit in patients with inflammatory diseases in which TNF-alpha is involved, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. As the use of adalimumab is becoming more widespread, cutaneous side effects are being increasingly reported. Various dermatologic adverse events have been reported in the literature, including injection site reactions, psoriasis-like eruption and pityriasis rosea. Herein, we describe a case of GA associated with adalimumab treatment for adult-onset Still's disease, which has not been reported in Korea.

A Case of Steroid and Methotrexate-Resistant Eosinophilic Fasciitis Treated with Adalimumab

Eosinophilic fasciitis (EF) is a rare fibrosing disorder characterized by painful swelling and induration of the limbs and trunk, characteristic histology with sclerosis and lymphocytic inflammation affecting the fascia. The cause and pathogenesis of EF are still unknown and current therapies include glucocorticoids with or without use of immunosuppressive agents. Recently, there have been several case reports documenting the efficacy of a TNF alpha inEosinophilic fasciitis (EF) is a rare fibrosing disorder characterized by painful swelling and induration of the limbs and trunk, characteristic histology with sclerosis and lymphocytic inflammation affecting the fascia. The cause and pathogenesis of EF are still unknown and current therapies include glucocorticoids with or without use of immunosuppressive agents. Recently, there have been several case reports documenting the efficacy of a TNF alpha inhibitor in EF following a steroid-resistant disease course. However, there has been no report on the experience in treatment of EF with a TNF alpha inhibitor in Korea. Hence, we report a case of steroid and methotrexate-resistant EF which was successfully treated with adalimumab, along with a review of the relevant articles.

New drugs for Rheumatoid arthritis / 대한내과학회지

Since the late 1990s, based on scientific advancement and biotechnological improvement, many effective drugs such as leflunomide and biologic agents for rheumatoid arthritis (RA) have been developed. These include TNF-alpha inhibitors such as etanercept, infliximab, and adalimumab, a peripheral B-cell depleting agent such as rituximab, CTLA-4 Ig such as abatacept, and IL-1 receptor antagonist such as anakira. These new agents have provided good efficacy in the treatment of patents with severe or refractory rheumatoid arthritis and have provided retardation or prevention of radiographic progression or joint destruction despite some side effects such as tuberculosis, infection, malignancies. In this review, new therapeutic alternatives would be given, and chances for more improved outcomes in the care of patients with rheumatoid arthritis provided.