Review Article

New Onset of Dermatomyositis/Polymyositis during Anti-TNF-α Therapies: A Systematic Literature Review

Table 1

Clinical characteristics of reported patients that developed polymyositis (PM)/dermatomyositis (DM) during anti-TNF-α therapy.

First author, yearNumber of patients (age, sex)Baseline diagnosisDuration of illness until anti-TNF-α initiationAnti-TNF-α therapyDuration of anti-TNF-α therapy until diagnosis of DM/PMConcomitant therapy during anti-TNF-α treatmentAutoantibodies before anti-TNF-α therapyAutoantibodies after anti-TNF-α therapyImprovement after withdrawal of anti-TNF-α therapy, treatment, and outcome

Musial, 2003 [14]1 (52 y, F)RA20 yInfliximab30 moPred + MTXANA 1: 320
dsDNA: neg
Jo-1: pos
ANA 1: 320
dsDNA 1: 20
Jo-1: pos
Yes, corticosteroids

Flendrie, 2003 [15]1 (NA)RANAInfliximabNANANANANA

Flendrie, 2005 [16]1 (52 y, F)RANALenercept2.5 moNANANAYes, NA

Urata, 2006 [17]1 (52 y, F)RA + pulmonary fibrosis33 yInfliximab9 moYes (pred + MTX) but only for 6 weeksANA 1: 640
dsDNA: neg
Jo-1: pos
ANA 1: 640
dsDNA: neg
Jo-1: pos
Yes, corticosteroids

Hall, 2006 [18]1 (44 y, F)Seronegative RA1 yEtanercept6 moMTXANA: neg
Anti-CCP: neg
Jo-1: neg
ANA 1: 640
dsDNA: NA
Jo-1: pos
Yes, corticosteroids

Liozon, 2007 [19]1 (47 y, F)RA6 moAdalimumab9 moPred (for 3 mo) and MTXANA 1: 640
dsDNA: pos
Jo-1: neg
Anti-CCP: pos
ANA 1: 2560
dsDNA: pos
Jo-1: NA
Anti-PM-Scl: pos
Yes, corticosteroids

Kiltz, 2008 [20]2 pts (46 y, M)AS17 yInfliximab6 moNAANA: negANA: negYes, corticosteroids
(57 y, F)RA26 yEtanercept30 moNoANA 1: 160ANA 1: 2560Yes, pred + cyclophosphamide, but fatal outcome sepsis due to Pneumocystis jiroveci (carinii) pneumonia

Ramos-Casals, 2008 [21]4 pts (NA)RANAInfliximab, etanercept, lenerceptNANA NANANA

Brunasso, 2010 [22]1 (45 y, F)RA13 yAdalimumab34 moNoANA: negANA 1: 320
Jo-1: neg
Yes, corticosteroids

Klein, 2010 [23]3 pts (40 y, F)RANAEtanercept2 yNoNAANA: pos
dsDNA: neg
Jo-1: neg
Partial improvement, corticosteroids, recurrence after 8 mo
(29 y, F)Seronegative arthritis with familiar history of psoriasisNAAdalimumab3 moMTXNAANA 1: 640
dsDNA: neg
Jo-1: neg
Yes, corticosteroids + methotrexate + azathioprine + quinacrine
(51 y, F)RANAAdalimumab2 moNoNANAYes, corticosteroids

Ishikawa, 2011 [24]1 (52 y, F)RA + NSIP3 yEtanercept2 moNoANA: pos
dsDNA: neg
Jo-1: pos
Anti-CCP: pos
ANA 1: 320
dsDNA: neg
Jo-1: pos
Yes, corticosteroids, but relapse of PM after 2 weeks

Ishikawa, 2011 [24]1 (52 y, M)RA + ILD12 yEtanercept26 moNANA
Anti-PL-7
ANA: negYes, corticosteroids

Ishikawa, 2011 [24]1 (63 y, F)RA + NSIP4 moEtanercept2 moTacrolimus + predAnti-CCP: pos
ANA: NA
ANA 1: 320 
anti-PL-12: pos
Yes, corticosteroids

Riolo, 2012 [25] 1 (36 y, M) Crohn’s disease 1 yAdalimumab2 weeksNoANA 1: 640
dsDNA: neg
Anti-U1 RNP: pos
ANA 1: 640
dsDNA: neg
Anti-U1 RNP: pos
Yes, corticosteroids + methotrexate
Infliximab1 moPred + MTXANA 1: 640
dsDNA: neg
Anti-U1 RNP: pos
ANA 1: 640
dsDNA: neg
Anti-U1 RNP: pos
Yes, corticosteroids + methotrexate

DM: dermatomyositis, PM: polymyositis, y: years, F: female, M: male, RA: rheumatoid arthritis, mo: months, ANA: antinuclear antibodies, neg: negative, pos: positive, NA: not available, pts: patients, AS: ankylosing spondilytis, NSIP: nonspecific interstitial pneumonia, ILD: interstitial lung disease.