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Joint Bone Spine. 2015 May;82(3):200-2. doi: 10.1016/j.jbspin.2014.12.003. Epub 2015 Jan 20.

Acquired hemophilia possibly induced by etanercept in a patient with rheumatoid arthritis.

Author information

1
Service de rhumatologie, CHU-Hôpitaux de Rouen, Inserm U905, CRB CIC 1404, IRIB, Université de Rouen, 76031 Rouen Cedex, France. Electronic address: totobanse@orange.fr.
2
Service de Médecine Interne, CHU-Hôpitaux de Rouen, Inserm U1096, IRIB, Université de Rouen, 76031 Rouen Cedex, France.
3
Service de rhumatologie, CHU-Hôpitaux de Rouen, Inserm U905, CRB CIC 1404, IRIB, Université de Rouen, 76031 Rouen Cedex, France.
4
Unité d'Hémostase, CHU-Hôpitaux de Rouen, Inserm U1096, IRIB, Université de Rouen, 76031 Rouen Cedex, France.

Abstract

A 47-year-old woman with rheumatoid arthritis (RA) treated successively with infliximab, abatacept, and etanercept spontaneously developed subcutaneous bruises and a noncompressive hematoma 11 months after starting etanercept therapy (50mg/week). Her prothrombin time was normal but her activated partial thromboplastin time was increased to 2.48 (normal range, 0.85-1.17). She had a circulating anticoagulant (Rosner index, 45; normal,<13) due to an anti-factor VIII antibody in a titer of 45 Bethesda units. Her factor VIII level was less than 1% (normal range, 55-150). The etanercept and leflunomide were stopped and prednisone was given in a daily dosage of 1mg/kg, in combination with rituximab, two 1-g doses at an interval of 2 weeks. After 5 months, persistence of the anti-factor VIII antibody prompted the initiation of azathioprine therapy, 2mg/kg/d. A remission was achieved 9 months after the diagnosis of acquired hemophilia and was sustained at last follow-up after 3 years. This new case of acquired hemophilia in a patient with RA may reflect a simple association or an inducing role of etanercept.

KEYWORDS:

Acquired hemophilia; Etanercept; Rheumatoid arthritis

PMID:
25617259
DOI:
10.1016/j.jbspin.2014.12.003
[Indexed for MEDLINE]

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