Hypereosinophilic syndrome—a rare adverse event of anti-cytokine treatment in rheumatoid arthritis resolved after Janus kinase inhibitor therapy

Abstract

Eosinophilia is uncommon in early rheumatoid arthritis (RA). The most frequent causes of hypereosinophilia during RA treatment are atopic eczema, allergy, helminth infection, haematological malignancy and drug-associated complications. The pathogenesis of this abnormality associated with anti-cytokine therapy is still unknown. We report the case of a young woman with RA and eosinophilia accompanied by systemic symptoms such as dyspnoea, fluid retention and eosinophilic vasculitis. An interesting observation was the persistence of eosinophilia during treatment with various biologics and its normalization after switching to the Janus kinase inhibitor baricitinib.

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References

  1. 1.

    Kovalszki A, Weller PF (2016) Eosinophilia. Prim Care 43(4):607–617

    Article  Google Scholar 

  2. 2.

    Guellec D, Milin M, Cornec D, Tobon GJ, Marhadour T, Jousse-Joulin S, et al (2015) Eosinophilia predicts poor clinical outcomes in recent-onset arthritis: results from the ESPOIR cohort. RMD Open 2015; published on 15 July. https://doi.org/10.1136/rmdopen-2015-000070

  3. 3.

    Panush RS, Franco AE, Schur PH (1971) Rheumatoid arthritis associated with eosinophilia. Ann Intern Med 75(2):199–205

    CAS  Article  Google Scholar 

  4. 4.

    Rothenberg ME (1998) Eosinophilia. N Engl J Med 338(22):1592–1600

    CAS  Article  Google Scholar 

  5. 5.

    Savolainen HA, Leirisalo-Repo M (2001) Eosinophilia as a side-effect of methotrexate in patients with chronic arthritis. Clin Rheumatol 20(6):432–434

    CAS  Article  Google Scholar 

  6. 6.

    Edelman J, Davis P, Gwen ET (1983) Prevalence of eosinophilia during gold therapy for rheumatoid arthritis. J Rheumatol 10:121

    CAS  PubMed  Google Scholar 

  7. 7.

    Nakahigashi K, Egawa G, Miyachi Y, Kabashima K (2014) Digital vasculitis with eosinophilia possibly associated with etanercept therapy. Acta Derm Venereol 94(2):239–240

    Article  Google Scholar 

  8. 8.

    Azuma N, Matsui K, Hashimoto N, Yoshikawa T, Sano H (2017) Successful switch to golimumab for eosinophilia and skin symptoms related to multiple biologics in a patient with rheumatoid arthritis. Intern Med 56(12):1585–1590

    CAS  Article  Google Scholar 

  9. 9.

    Kay J, Matteson EL, Dasgupta B, Nash P, Durez P, Hall S, Hsia EC, Han J, Wagner C, Xu Z, Visvanathan S, Rahman MU (2008) Golimumab in patients with active rheumatoid arthritis despite treatment with methotrexate: a randomized, double-blind, placebo-controlled, dose-ranging study. Arthritis Rheum 58(4):964–975

    CAS  Article  Google Scholar 

  10. 10.

    Leu JH, Adedokun OJ, Gargano C, Hsia EC, Xu Z, Shankar G (2019) Immunogenicity of golimumab and its clinical relevance in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Rheumatology (Oxford) 58(3):441–446

    CAS  Article  Google Scholar 

  11. 11.

    Jani M, Isaacs JD, Morgan AW, Wilson AG, Plant D, Hyrich KL, Chinoy H, Barton A, BRAGGSS (2017) High frequency of antidrug antibodies and association of random drug levels with efficacy in certolizumab pegol-treated patients with rheumatoid arthritis: results from the BRAGGSS cohort. Ann Rheum Dis 76(1):208–213

    CAS  Article  Google Scholar 

  12. 12.

    Ogata A, Tanimura K, Sugimoto T, Inoue H, Urata Y, Matsubara T, Kondo M, Ueki Y, Iwahashi M, Tohma S, Ohta S, Saeki Y, Tanaka T, the Musashi Study Investigators (2014) Phase III study of the efficacy and safety of subcutaneous versus intravenous tocilizumab monotherapy in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken) 66:344–354

    CAS  Article  Google Scholar 

  13. 13.

    Simon HU, Blaser K (1995) Inhibition of programmed eosinophil death: a key pathogenic event for eosinophilia? Immunol Today 16:53–55

    CAS  Article  Google Scholar 

  14. 14.

    Bystrom J, Clanchy FI, Taher TE (2017) Response to treatment with TNFα inhibitors in rheumatoid arthritis is associated with high levels of GM-CSF and GM-CSF+ T lymphocytes. Clin Rev Allergy Immunol 53(2):265–276

    CAS  Article  Google Scholar 

  15. 15.

    Simon HU, Yousefi S, Dibbert B, Levi-Schaffer F, Blaser K (1997) Anti-apoptotic signals of granulocyte-macrophage colony-stimulating factor are transduced via JAK2 tyrosine kinase in eosinophils. Eur J Immunol 27(12):3536–3539

    CAS  Article  Google Scholar 

  16. 16.

    Yousefi S, Hoessli DC, Blaser K, Mills GB, Simon HU (1996) Requirement of Lyn and Syk tyrosine kinases for the prevention of apoptosis by cytokines in human eosinophils. J Exp Med 183(4):1407–1414

    CAS  Article  Google Scholar 

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Correspondence to Emőke Šteňová.

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Šteňová, E., Tarabčáková, L., Babál, P. et al. Hypereosinophilic syndrome—a rare adverse event of anti-cytokine treatment in rheumatoid arthritis resolved after Janus kinase inhibitor therapy. Clin Rheumatol (2020). https://doi.org/10.1007/s10067-020-05134-z

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Keywords

  • Anti-cytokine therapy
  • Baricitinib
  • Eosinophilia
  • Rheumatoid arthritis
  • Vasculitis