Academic Rheumatology Centre, Dipartimento di Scienze Cliniche e Biologiche Università di Torino - AO Mauriziano di Torino, Turin, Italy.
Pathology Unit, Mauriziano Hospital, Turin, Italy.
Autoimmun Rev. 2024 Mar;23(3):103481. doi: 10.1016/j.autrev.2023.103481. Epub 2023 Nov 24.
To report cases of new onset sarcoidosis upon biologic (bDMARDs) treatment administration in patients with seronegative inflammatory arthritis in a real-life cohort, alongside a systematic literature review (SLR) on this topic.
We performed a retrospective analysis on clinical records of patients with seronegative arthritis followed up in a monocentric cohort who underwent bDMARDs treatment due to the underlying rheumatic disease and described any newly diagnosed sarcoidosis in this cohort. Only ascertained cases with available radiological and/or histological documentation were considered. A SLR on new-onset sarcoidosis in seronegative arthritis receiving bDMARDs was performed across MEDLINE (through PubMed), Scopus and Ovid (Cochrane, Embase) electronic databases using appropriate strings.
In our cohort, 4 new-onset cases of sarcoidosis were reported among patients with seronegative inflammatory arthritis receiving biologics. Three out of 4 patients were receiving anti-tumor necrosis factor alpha (TNFα) while 1 patient was on secukinumab (anti-IL17A) prior to sarcoidosis onset. The SLR disclosed 46 new-onset sarcoidosis cases upon biological treatment for seronegative arthritis, of whom 43 occurred during treatment with anti-TNFα, while 3 during anti-IL-17A therapy. In our cohort as well as in the majority of cases reported in the SLR, sarcoidosis presented with lymph nodal and lung involvement and displayed a benign course with spontaneous resolution in about 1 fourth of the cases.
The use of biologics may relate to the onset of sarcoidosis; hence, clinicians must remain aware of the potential occurrence or reactivation of sarcoidosis when starting biologic treatment in patients with inflammatory arthritis, performing adequate patient assessment and surveillance. Since TNFα inhibitors may represent a therapeutic option for sarcoidosis, further evaluation on larger cohorts is needed to investigate any causal link with the development of sarcoidosis.
在一项真实队列中，报告生物制剂（bDMARDs）治疗后血清阴性炎症性关节炎患者新发结节病病例，并进行系统性文献综述（SLR）。
我们对在单中心队列中接受 bDMARDs 治疗的血清阴性关节炎患者的临床记录进行回顾性分析，这些患者因基础风湿病而接受 bDMARDs 治疗，并在该队列中描述任何新诊断的结节病。仅考虑有可用影像学和/或组织学资料证实的病例。我们在 MEDLINE（通过 PubMed）、Scopus 和 Ovid（Cochrane、Embase）电子数据库中进行了 SLR，使用适当的字符串搜索接受 bDMARDs 治疗的血清阴性关节炎新发结节病的病例。
在我们的队列中，报告了 4 例接受生物制剂治疗的血清阴性炎症性关节炎患者新发结节病。4 例患者中有 3 例在结节病发病前接受了抗肿瘤坏死因子-α（TNFα）治疗，1 例接受了司库奇尤单抗（抗 IL-17A）治疗。SLR 共发现 46 例接受生物治疗的血清阴性关节炎新发结节病病例，其中 43 例发生在抗 TNFα 治疗期间，3 例发生在抗 IL-17A 治疗期间。在我们的队列中以及 SLR 中报告的大多数病例中，结节病表现为淋巴结和肺部受累，约 1/4 的病例呈良性病程，自发性缓解。
生物制剂的使用可能与结节病的发病有关；因此，临床医生在开始对炎症性关节炎患者进行生物治疗时，必须意识到结节病发生或再激活的潜在可能性，进行充分的患者评估和监测。由于 TNFα 抑制剂可能是结节病的一种治疗选择，因此需要在更大的队列中进一步评估，以研究与结节病发生之间的任何因果关系。
