Sinusitis: a possible link with adalimumab
Muhammad Haroon1, Ursula Bond, Mark Phelan
1Arthritis and Osteoporosis Centre, South Infirmary-Victoria University Hospital, Cork, Republic of Ireland. mharoon301@hotmail.com
Abstract:
The experience with anti-TNF agents is relatively short; and with time, we are learning more about the frequency of occurrence of different adverse events as the original trials were either too small or too brief. We report a case series of four patients who suffered from chronic inflammatory arthritis [rheumatoid arthritis (n = 3) and psoriatic arthritis (n = 1)]. Their inflammatory arthritis remained refractory to increasing doses of methotrexate up to 20 mg weekly and required an advance in treatment to TNF antagonists. However, within a few weeks of commencing these patients on adalimumab, they developed newly diagnosed recurring sinusitis. All these patients were assessed by otorhinolaryngologists, and had clinically confirmed diagnosis. The sinusitis remained refractory to standard medications; however, it resolved after the discontinuation of adalimumab. Although FDA and Irish Pharmaceutical Health Association describe that adalimumab use increases the risk of non-serious infections marginally and most of the patients continued on Humira (adalimumab) after the infection was resolved, however, our recent observation raises the concern of probable higher incidence.
Insights
This case series suggests adalimumab may increase the risk of chronic sinusitis in patients with inflammatory arthritis. Discontinuation of adalimumab resolved sinusitis, indicating a potential link between this TNF antagonist and recurrent sinus infections.
Area of Science:
- Rheumatology
- Immunology
- Otolaryngology
Background:
- Anti-TNF agents are increasingly used for inflammatory arthritis.
- Long-term adverse event data for TNF antagonists like adalimumab are still emerging.
- Previous trials had limitations in sample size and duration for adverse event assessment.
Purpose of the Study:
- To report a case series of patients developing sinusitis during adalimumab treatment.
- To investigate the potential association between adalimumab and chronic sinusitis.
- To highlight the clinical course and management of sinusitis in this context.
Main Methods:
- Case series of four patients with refractory rheumatoid arthritis or psoriatic arthritis.
- Treatment escalation to adalimumab (Humira).
- Clinical assessment and diagnosis of sinusitis by otorhinolaryngologists.
Main Results:
- Four patients developed newly diagnosed, recurring sinusitis within weeks of starting adalimumab.
- Sinusitis was refractory to standard medical treatment.
- Discontinuation of adalimumab led to the resolution of sinusitis in all patients.
Conclusions:
- Adalimumab treatment may be associated with a higher incidence of chronic sinusitis than previously reported.
- Physicians should be vigilant for sinusitis as a potential adverse event in patients on adalimumab.
- Further research is warranted to confirm this association and elucidate the underlying mechanisms.
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