Accelerated Cutaneous Nodulosis During Infliximab Therapy in a Patient w/Rheumatoid Arthritis

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Accelerated Cutaneous Nodulosis During Infliximab Therapy in a Patient

With Rheumatoid Arthritis.

Journal of Clinical Rheumatology. 10(6):336-338, December 2004.

Abstract:

Up to one fourth of patients with rheumatoid arthritis (RA) may have

extraarticular findings such as subcutaneous nodules. These are discrete

subcutaneous granulomatous nodules located on extensor surfaces,

especially of the elbows.

Over the past 10 to 15 years, there have been reports of accelerated

cutaneous nodulosis in patients receiving methotrexate therapy.

Recently, antitumor necrosis factor [alpha] (anti-TNF[alpha]) biologic

therapy has become commonplace in the management of RA, especially in

methotrexate-resistant or toxic patients. There have been recent reports

of accelerated nodulosis in patients with RA on etanercept.

We describe what we believe is the first case of accelerated cutaneous

nodulosis resulting from infliximab anti-TNF[alpha] therapy in a patient

with RA.

One year after the initiation of infliximab, with RA in remission, our

patient noted the rapid development of rheumatoid nodules of both hands.

A biopsy was characteristic of a rheumatoid nodule, revealing palisading

granulomas and fibrinoid necrosis.

Mackley, L. MD; Ostrov, Barbara E. MD; Ioffreda, D. MD