Giant cell arteritis during adalimumab treatment for rheumatoid arthritis

Giant cell arteritis, polymyalgia rheumatica, and late-onset rheumatoid arthritis: Can they be components of a single disease process in elderly patients?

“…While it can be considered a sheer coincidence, it can also lead us to think of a causal relationship: the discontinuation of the drugs probably eased the way for a second disease. In contrast, GCA developed in 2 cases with RA while they were still under treatment with TNF-alpha blockers, including adalimumab and etanercept (9,10). TNF-alpha blockers have been considered for treating vasculitis such as GCA.…”

“…TNF-alpha blockers have been considered for treating vasculitis such as GCA. On the other hand, cases of vasculitis induced by anti-TNF blockers have also been reported (9,10). Exactly how mechanism underlying vasculitis induced by anti-TNF-alpha blockers works remains unknown.…”

Biologic Therapy for the Treatment of Giant Cell Arteritis

“…33 Etanercept, a soluble TNF-receptor fusion protein, which also binds TNFa, is administered subcutaneously as a weekly 50 mg dose. Worth noting are descriptions of the development of GCA in patients taking adalimumab 34 or etanercept 35 for rheumatoid arthritis. These findings warrant caution in the use of TNFa inhibitors for GCA, even in refractory cases.…”

Biologic Agents for the Treatment of Systemic Vasculitis

“…Adalimumab, a fully humanized monoclonal antibody directed against TNF, was successfully used only in one case of giant cell arteritis refractory to steroid therapy (Ahmed et al, 2007) . There are also two isolated reports of new-onset giant cell arteritis in patients receiving etanercept and adalimumab associated with methotrexate for rheumatoid arthritis (Leydet-Quilici 2007;Seton, 2004). Finally a single report has described successful in treating giant cell arteritis with Rituximab combined with cyclophosphamide (Bhatia et al, 2005).…”