To describe the clinical characteristics, histopathologic features, and outcomes of
patients in whom vasculitis developed in association with use of tumor necrosis factor-α
Patients and Methods
This is a retrospective review of patients evaluated at Mayo Clinic, Rochester, Minnesota,
from January 1, 1998, through March 31, 2011, with a diagnosis of vasculitis induced
by anti–TNF-α therapy.
Of 8 patients with vasculitis associated with anti–TNF-α therapy (mean age, 48.5 years),
6 (75%) were female. Four (50%) had rheumatoid arthritis, 1 (13%) had Crohn disease,
and 3 (38%) had ulcerative colitis. Five (63%) were treated with infliximab, 2 (25%)
with etanercept, and 1 (13%) with adalimumab. The mean duration of treatment before
development of vasculitis was 34.5 months. The skin was the predominant organ affected
(5 patients [63%]), with the most common cutaneous lesion being palpable purpura (4
of 5 [80%]). Two organs involved in systemic vasculitis were the peripheral nervous
system (4 patients [50%]) and kidney (1 patient [13%]). All cases of vasculitis were
histopathologically confirmed. Seven of 8 patients improved with discontinuation of
therapy (mean time to resolution, 6.9 months) and adjuvant treatment (all 8 received
prednisone; another agent was also used in 7); rechallenge with anti–TNF-α therapy
was not attempted in any patient. At last follow-up, no patients had experienced a
recurrence of vasculitis after therapy discontinuation.
Cutaneous small-vessel vasculitis was the most common finding, but systemic vasculitis,
including peripheral nerve and renal vasculitis, was also frequently observed.