Can tumor necrosis factor inhibitors induce scleritis ?

Purpose Tumor necrosis factor alpha is a pro‐inflammatory cytokine which plays an important role in the physiology of many inflammatory diseases. There are three tumor necrosis factor inhibitors : etanercept, infliximab, adalimumab. Etanercept’s most consistent side effect is injection‐site reaction. Inflammatory eye disease has also been one of the rare adverse events associated with etanercept. Methods We report two cases of female patients who presented a scleritis , while they were treated for rheumatoid arthritis by etanercept 35 mg twice a week. Results These two patients presented a first episode of unilateral anterior nodular scleritis after respectively 16 and 12 months of etanercept. Their rheumatoid disease was in remission. The non steroidal anti‐inflammatory agents and steroids were not much effective on the scleritis symptoms. After having stopped the etanercept, the scleritis decreased. A review of the literature pertaining to inflammatory eye disease associated with the use of etanercept was performed. Multiples drugs have been associated with ocular inflammation : in scleritis (biphosphonates, topiramate) and in uveitis (rifabutine, sulfonamides, metipranolol eyedrops,…). These cases suggest that etanercept is one of them. Conclusion The possibility of a iatrogenic cause must be envisaged in case of non efficacity of usual treatment (non steroidal anti‐inflammatory agents, steroids, immunosuppressive therapies). The question of a specific ophthalmological follow‐up of such patients is also addressed.