PMID- 37845415
OWN - NLM
STAT- MEDLINE
DCOM- 20240202
LR  - 20240223
IS  - 1434-9949 (Electronic)
IS  - 0770-3198 (Linking)
VI  - 43
IP  - 2
DP  - 2024 Feb
TI  - Etanercept-associated episcleritis: a pediatric case report of a paradoxical 
      adverse reaction and review of the literature.
PG  - 799-808
LID - 10.1007/s10067-023-06793-4 [doi]
AB  - Scleritis is an inflammation of the episcleral and scleral tissues, characterized 
      by injection in both superficial and deep episcleral vessels. When only 
      episcleral tissue is involved, it is referred to as episcleritis. Episcleritis is 
      mainly idiopathic but may be secondary to an underlying rheumatologic disease. 
      Despite being rare, drug-associated episcleritis and scleritis should also be 
      included in the differential diagnosis. Tumor necrosis factor-alpha (TNF-alpha) 
      inhibitors are generally well-tolerated, but etanercept, in particular, has the 
      potential to cause paradoxical adverse reactions including ocular inflammations, 
      such as uveitis, scleritis, and ocular myositis. Etanercept differs in its 
      mechanism of action from other TNF-alpha inhibitors as it acts as a decoy receptor, 
      and this may partly explain the more frequently reported etanercept-associated 
      ocular inflammation. Etanercept may also be ineffective in preventing ocular 
      inflammation. However, the dechallenge and rechallenge phenomena have proven 
      there is a causative link between etanercept and new-onset ocular inflammation. 
      We report a case of a 15-year-old boy with enthesitis-related arthritis and 
      familial Mediterranean fever who presented with episcleritis and blepharitis 
      while receiving etanercept treatment and subsequently showed dechallenge and 
      rechallenge reactions. Therefore, physicians should also be aware that 
      episcleritis should be considered a paradoxical adverse reaction to etanercept 
      and can occur in pediatric patients. We also reviewed the English literature to 
      provide an overview and evaluate intervention options.
CI  - (c) 2023. The Author(s), under exclusive licence to International League of 
      Associations for Rheumatology (ILAR).
FAU - Kucukali, Batuhan
AU  - Kucukali B
AUID- ORCID: 0000-0002-4268-8603
AD  - Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, 
      Ankara, Turkey. batuhankucukali@gmail.com.
FAU - Gezgin Yildirim, Deniz
AU  - Gezgin Yildirim D
AUID- ORCID: 0000-0002-4823-2076
AD  - Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, 
      Ankara, Turkey.
FAU - Esmeray Senol, Pelin
AU  - Esmeray Senol P
AUID- ORCID: 0000-0002-9493-9355
AD  - Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, 
      Ankara, Turkey.
FAU - Ozdemir, Huseyin Baran
AU  - Ozdemir HB
AUID- ORCID: 0000-0002-5585-253X
AD  - Department of Opthalmology, Gazi University Faculty of Medicine, Ankara, Turkey.
FAU - Bakkaloglu, Sevcan A
AU  - Bakkaloglu SA
AUID- ORCID: 0000-0001-6530-9672
AD  - Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, 
      Ankara, Turkey.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20231017
PL  - Germany
TA  - Clin Rheumatol
JT  - Clinical rheumatology
JID - 8211469
RN  - OP401G7OJC (Etanercept)
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Male
MH  - Humans
MH  - Child
MH  - Adolescent
MH  - Etanercept/adverse effects
MH  - *Scleritis/chemically induced
MH  - Tumor Necrosis Factor-alpha
MH  - *Uveitis/complications
MH  - Inflammation/complications
OTO - NOTNLM
OT  - Episcleritis
OT  - Etanercept
OT  - Ocular inflammation
OT  - Paradoxical adverse reaction
EDAT- 2023/10/17 00:42
MHDA- 2024/02/02 06:43
CRDT- 2023/10/16 23:37
PHST- 2023/08/21 00:00 [received]
PHST- 2023/10/09 00:00 [accepted]
PHST- 2023/10/08 00:00 [revised]
PHST- 2024/02/02 06:43 [medline]
PHST- 2023/10/17 00:42 [pubmed]
PHST- 2023/10/16 23:37 [entrez]
AID - 10.1007/s10067-023-06793-4 [pii]
AID - 10.1007/s10067-023-06793-4 [doi]
PST - ppublish
SO  - Clin Rheumatol. 2024 Feb;43(2):799-808. doi: 10.1007/s10067-023-06793-4. Epub 
      2023 Oct 17.