Retroperitoneal Fibrosis During Etanercept Therapy for Rheumatoid Arthritis

Abstract

To the Editor: Retroperitoneal fibrosis (RPF) is a rare disease characterized by fibroinflammatory tissue surrounding the abdominal aorta and frequently encasing the ureter1. Empirical therapy includes high doses of corticosteroids as first-line treatment, and in some refractory cases immunosuppressive agents such as azathioprine, mycophenolate mofetil, or tamoxifen1. However, some patients fail to respond to immunosuppressive treatment. New drugs are needed for this patient subset. Catanoso, et al reported the case of a woman with idiopathic RPF whose condition improved after receiving infliximab, a monoclonal antibody directed against tumor necrosis factor-α (TNF-α)2. In contrast, we describe the cases of 2 patients who developed RPF while receiving etanercept, a soluble receptor, another TNF-α blocker for RA. In the Rheumatology Department of Clermont-Ferrand Teaching Hospital, 2 patients with rheumatoid arthritis (RA) developed RPF while receiving TNF-α blockers for RA. A 57-year-old man was effectively treated with etanercept 50 mg/week for seronegative RA for 4 years. He was also treated with perindopril for arterial hypertension and rosuvastatin and aspirin for lower limb arterial disease. He presented with acute lower back pain with fever in 2004. Inflammatory markers were slightly elevated: erythrocyte sedimentation rate (ESR) 31 mm/h, upper limit … Address correspondence to Dr. M. Couderc, Rheumatology Department, Clermont-Ferrand Teaching Hospital, Place Henri Dunant, 63000 Clermont-Ferrand, France. E-mail: mcouderc{at}chu-clermontferrand.fr