Two U.S. doctors report another suspected case of lupuslike syndrome associated with use of the TNF-alpha medication etanercept (Enbrel, Amgen/Wyeth), a drug that is sometimes prescribed to people with spondylitis. As reported in a previous Spondylitis Association of America news brief, there have been five other reported cases of lupuslike syndrome associated with etanercept, but in this sixth case, the lupuslike disease seemed quite severe.

Drs. Elise Carlson and Naomi Rothfield (University of Connecticut Health Center, Farmington, CT) say, "We believe there is a probable association between the onset of lupuslike disease and etanercept therapy."

Their patient is a 45-year-old woman with rheumatoid arthritis who began taking etanercept in October 1999. In December 2001, the woman sought treatment for hair loss and purple skin lesions on her extremities, along with other abnormalities that showed up in laboratory tests. After evaluation, the woman was told to discontinue etanercept and began treatment with 40 mg/day of prednisone. Seven months later, there has been hair regrowth and no recurrence of skin lesions. Most of the other problems that showed up in laboratory results (like abnormal antidouble stranded DNA) are "slowly moving toward the normal range". Yet other laboratory abnormalities have persisted.

Carlson and Rothfield explain that the previous five cases of lupuslike syndrome associated with etanercept have all experienced autoimmune skin rashes that resolved upon discontinuation of etanercept. This woman's case was the only one reported to have certain other associated problems that showed up in laboratory tests.

"Our patient's condition has improved with discontinuation of etanercept, and her autoimmunity markers are showing a trend toward normal values," they explain. "Unlike previously described patients receiving etanercept, she developed antibodies to extractable nuclear antigens. Although a renal biopsy was not pursued, she did have evidence of persistent red blood cells in her urine sediment; this has resolved with blood pressure management, prednisone therapy, and the discontinuation of etanercept."