Klein Rachel, Rosenbach Misha, Kim Ellen J, Kim Brian, Werth Victoria P, Dunham Jonathan
Department of Medicine, Division of Rheumatology, University of Pennsylvania School of Medicine, Perelman Center for Advanced Medicine, First Floor South Pavilion, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA.
Arch Dermatol. 2010 Jul;146(7):780-4. doi: 10.1001/archdermatol.2010.142.
Dermatomyositis is an autoimmune disease of unknown etiology characterized by inflammation of the skin and muscles. Several medications have been implicated in the development of dermatomyositis; however, the disease has rarely been linked to the use of tumor necrosis factor (TNF) inhibitors. We report 4 cases of dermatomyositis that developed or were exacerbated by exposure to the TNF inhibitors etanercept and adalimumab. Observation Four patients with symptoms of inflammatory arthritis were treated with TNF inhibitors for a duration ranging from 2 months to 2 years. All 4 patients developed symptoms consistent with dermatomyositis, including inflammatory rash and muscle weakness. Their symptoms persisted after discontinuation of the treatment with the TNF inhibitors but responded to treatment with corticosteroids and immunosuppressive medications.
Tumor necrosis factor inhibitors have been associated with the onset of a number of autoimmune disorders, most commonly vasculitis and a lupuslike syndrome. Rarely have they been associated with dermatomyositis. The 4 cases reported herein indicate that TNF inhibitor use can be associated with either induction or exacerbation of dermatomyositis.
皮肌炎是一种病因不明的自身免疫性疾病，其特征为皮肤和肌肉炎症。多种药物与皮肌炎的发生有关；然而，该疾病很少与肿瘤坏死因子（TNF）抑制剂的使用相关联。我们报告了4例因接触TNF抑制剂依那西普和阿达木单抗而发生或加重的皮肌炎病例。
4例炎性关节炎症状患者接受TNF抑制剂治疗2个月至2年。所有4例患者均出现了与皮肌炎相符的症状，包括炎性皮疹和肌肉无力。在停用TNF抑制剂治疗后，他们的症状持续存在，但对皮质类固醇和免疫抑制药物治疗有反应。
肿瘤坏死因子抑制剂与多种自身免疫性疾病的发生有关，最常见的是血管炎和狼疮样综合征。它们很少与皮肌炎相关联。本文报告的4例病例表明，使用TNF抑制剂可能与皮肌炎的诱发或加重有关。
