Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jun 30;32(2):96-103.
doi: 10.31138/mjr.32.2.96. eCollection 2021 Jun.

Biologic Therapies and Autoimmune Phenomena

Alexandros A Drosos  1 , Eleftherios Pelechas  1 , Evripidis Kaltsonoudis  1 , Theodora E Markatseli  1 , Paraskevi V Voulgari  1
Affiliations
Review

Biologic Therapies and Autoimmune Phenomena

Alexandros A Drosos et al. Mediterr J Rheumatol. .

Abstract

The use of biologic medications has represented a great advancement in the treatment of autoimmune rheumatic diseases. Despite their excellent efficacy, during the last years, a growing number of reports of autoimmune phenomena and paradoxical inflammation has emerged. These phenomena may range from the discovery of an isolated autoantibody to full-blown autoimmune diseases, organ-specific and systemic. This review has been carried out in order to underline the multitude of the potential adverse manifestations from the use of biologic medications. Thus, early recognition of specific types of autoimmune phenomena is an imperative for the physicians allowing them to have an accurate diagnosis and treatment.

Keywords: Biologic agents; adverse events; autoimmune phenomena; paradoxical inflammation; treatment.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
A 26-year-old woman with seropositive rheumatoid arthritis refractory to methotrexate received adalimumab 40mg every 14 days subcutaneously. She responded very well, but 6 months later she developed erythematous eruptions affecting her face in a butterfly distribution and with blister formation.
Figure 2.
Figure 2.
A 62-year-old man with seropositive rheumatoid arthritis refractory to methotrexate and leflunomide was treated with SB4, an etanercept biosimilar 50mg/week subcutaneously. After 3 months he developed psoriasiform eruptions affecting the palms of the hands.
Figure 3.
Figure 3.
A 65-year-old man with seropositive rheumatoid arthritis refractory to methotrexate and infliximab. He was treated with tocilizumab 162mg/week subcutaneously. He responded very well to the above treatment but eight months later he developed polycyclic skin rashes affecting the lower extremities. The histological picture was compatible with granuloma annulare.
Figure 4.
Figure 4.
The same patient as in Figure 2, two months later after discontinuation of SB4 receiving small doses of prednisone. Note the complete resolution of the psoriasiform skin rashes.
Figure 5.
Figure 5.
The same patient as in Figure 3, three months later after tocilizumab discontinuation receiving prednisone 10mg/day. Note the complete resolution of granuloma annulare eruptions.
See this image and copyright information in PMC

References

    1. Drayton DL, Liao S, Mounzer RH, Ruddle NH.Lymphoid organ development: from ontogeny to neogenesis. Nat Immunol 2006;7(4):344–53. - PubMed
    1. Davidson A, Diamond B.Autoimmune diseases. N Engl J Med 2001;345(5):340–50. - PubMed
    1. Rosman Z, Shoenfeld Y, Zandman-Goddard G.Biologic therapy for autoimmune diseases: an update. BMC Med 2013;11:88. - PMC - PubMed
    1. Burmester GR, Feist E, Dorner T.Emerging cell and cytokine targets in rheumatoid arthritis. Nat Rev Rheumatol 2014;10(2):77–88. - PubMed
    1. Pichler WJ.Adverse side-effects to biological agents. Allergy 2006;61(8):912–20. - PubMed

LinkOut - more resources