Department of Internal Medicine, Rheumatology Clinic, Medical School, University of Ioannina, 45110, Ioannina, Greece.
Department of Pathology, Medical School, University of Ioannina, Ioannina, Greece.
Rheumatol Int. 2019 Feb;39(2):353-357. doi: 10.1007/s00296-018-4212-0. Epub 2018 Dec 7.
Granuloma annulare (GA) is the most common non-infectious disease. Despite the fact that it is a benign disease, it can be associated with a variety of disorders and certain drugs including biological disease-modifying anti-rheumatic drugs (bDMARDs). A 50-year-old man with a history of rheumatoid arthritis refractory to methotrexate, hydroxychloroquine and infliximab was treated with tocilizumab (TCZ), an interleukin-6 receptor antagonist, 162 mg subcutaneously every week. The patient responded very well to TCZ treatment with a decrease of acute phase reactants and reduction of disease activity score for 28-joints count. However, 3 months later he developed erythematous polycyclic eruptions affecting the lower extremities consistent with a diagnosis of GA which was confirmed by a skin biopsy. TCZ has been discontinued and the patient was treated with prednisone presenting complete resolution of skin manifestations after 4 weeks. This is the first case of GA development during TCZ treatment. Thus, we review the literature and discuss the relevant cases of GA development in patients treated with bDMARDs. When dealing with patients treated with these agents, all physicians should be aware of possible adverse events and the potential development of such complications.
环状肉芽肿（GA）是最常见的非传染性疾病。尽管它是一种良性疾病，但它可能与多种疾病和某些药物有关，包括生物疾病修饰抗风湿药物（bDMARDs）。一名 50 岁男性，有甲氨蝶呤、羟氯喹和英夫利昔单抗难治性类风湿关节炎病史，接受白细胞介素-6 受体拮抗剂托珠单抗（TCZ）治疗，每周皮下注射 162mg。患者对 TCZ 治疗反应非常好，急性期反应物下降，28 关节计数疾病活动评分降低。然而，3 个月后，他出现了影响下肢的红斑多环形皮疹，符合 GA 的诊断，皮肤活检证实了这一点。TCZ 已停用，患者接受泼尼松治疗，4 周后皮肤表现完全消退。这是 TCZ 治疗期间 GA 发展的首例病例。因此，我们回顾了文献，并讨论了 bDMARDs 治疗患者中 GA 发展的相关病例。在处理接受这些药物治疗的患者时，所有医生都应该意识到可能出现的不良反应和发生此类并发症的潜在风险。
