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ID PMID Title PublicationDate abstract
22995428 Granulocyte-macrophage colony-stimulating factor is a key mediator in experimental osteoar 2012 Sep 20 INTRODUCTION: Granulocyte-macrophage colony-stimulating factor (GM-CSF) has been shown to be important in the development of inflammatory models of rheumatoid arthritis and there is encouraging data that its blockade may have clinical relevance in patients with rheumatoid arthritis. The aims of the current study were to determine whether GM-CSF may also be important for disease and pain development in a model of osteoarthritis. METHODS: The role of GM-CSF was investigated using the collagenase-induced instability model of osteoarthritis. We studied both GM-CSF-/- mice and wild-type (C57BL/6) mice treated prophylactically or therapeutically with a monoclonal antibody to GM-CSF. Disease development (both early and late) was evaluated by histology and knee pain development was measured by assessment of weight distribution. RESULTS: In the absence of GM-CSF, there was less synovitis and matrix metalloproteinase-mediated neoepitope expression at week 2 post disease induction, and less cartilage damage at week 6. GM-CSF was absolutely required for pain development. Therapeutic neutralization of GM-CSF not only abolished the pain within 3 days but also led to significantly reduced cartilage damage. CONCLUSIONS: GM-CSF is key to the development of experimental osteoarthritis and its associated pain. Importantly, GM-CSF neutralization by a therapeutic monoclonal antibody-based protocol rapidly and completely abolished existing arthritic pain and suppressed the degree of arthritis development. Our results suggest that it would be worth exploring the importance of GM-CSF for pain and disease in other osteoarthritis models and perhaps clinically for this form of arthritis.
31643785 Certolizumab. 2012 Certolizumab is a Fab fragment of a monoclonal antibody to human tumor necrosis factor alpha (TNFα) which has potent antiinflammatory activity and is used in the therapy of severe rheumatoid arthritis and inflammatory bowel disease. Certolizumab has had limited use and has yet to be specifically linked to instances of idiosyncratic acute liver injury or reactivation of hepatitis B, but is likely to cause similar hepatic injury to what has been described for other TNFα antagonists such as infliximab and adalimumab.
22264340 The balance of expression of PTPN22 splice forms is significantly different in rheumatoid 2012 Jan 20 BACKGROUND: The R620W variant in protein tyrosine phosphatase non-receptor 22 (PTPN22) is associated with rheumatoid arthritis (RA). The PTPN22 gene has alternatively spliced transcripts and at least two of the splice forms have been confirmed to encode different PTPN22 (LYP) proteins, but detailed information regarding expression of these is lacking, especially with regard to autoimmune diseases. METHODS: We have investigated the mRNA expression of known PTPN22 splice forms with TaqMan real-time PCR in relation to ZNF592 as an endogenous reference in peripheral blood cells from three independent cohorts with RA patients (n = 139) and controls (n = 111) of Caucasian origin. Polymorphisms in the PTPN22 locus (25 SNPs) and phenotypic data (gender, disease activity, ACPA and RF status) were used for analysis. Additionally, we addressed possible effects of methotrexate treatment on PTPN22 expression. RESULTS: We found consistent differences in the expression of the PTPN22 splice forms in unstimulated peripheral blood mononuclear cells between RA patients and normal controls. This difference was more pronounced when comparing the ratio of splice forms and was not affected by methotrexate treatment. CONCLUSIONS: Our data show that RA patients and healthy controls have a shift in balance of expression of splice forms derived from the PTPN22 gene. This balance seems not to be caused by treatment and may be of importance during immune response due to great structural differences in the encoded PTPN22 proteins.
22260068 [Eukaryotic expression of human IL17-RD-ECD and generation of its monoclonal antibody]. 2011 Oct IL-17 Receptor D (IL-17 RD) is a cytokine receptor that mediates IL-17 signaling and plays an important role in responding to the invasion of extracellular pathogens and many inflammatory and autoimmune diseases such as rheumatoid arthritis. In this study we report the generation of a mouse monoclonal antibody against human IL-17 RD. The recombinant human IL-17RD extracellular domain (hIL-17RD-ECD) was produced in the baculovirus expression system and purified from culture medium of sf9 insect cells. The purified protein was used as a T-dependent antigen to immune Balb/C mice. B cells from the spleen of immunized mice were fused with murine cell SP2/0. Hybridoma cell lines were screened for the production of the monoclonal antibody against hIL-17-RD-ECD using ELISA. A hybridoma cell line 1F8 was found to have a high production of the antibody, which was further confirmed for the specificity by both western blot and ELISA analyses. The monoclonal antibody obtained from hybridoma 1F8 was characterized to be IgG1+Kappa subclass. This study provided a base for the further therapeutic application of the antibody on the autoimmune disease including rheumatoid arthritis.
21516707 [Case of suspected pseudo-elevation of serum creatinine immediately after intra-articular 2011 We report a case of suspected pseudo-elevation of serum creatinine in a patient with rheumatoid arthritis, whose blood sample was obtained from his right cubital vein immediately after the intra-articular injection of 0.67 mg of a pharmaceutical preparation of dexamethasone (Decadron) containing creatinine as a buffer into his right wrist joint to alleviate arthralgia. The 61-year-old male patient, who had been treated for rheumatoid arthritis, was referred to our outpatient clinic by his family doctor because of sudden elevation of his serum creatinine, which hitherto had been normal. Acute kidney injury (AKI) was suspected, but his medical history, physical examinations, and laboratory findings did not support the diagnosis of AKI. The preserved serum sample obtained when the elevation of his serum creatinine was reported was examined and revealed that the serum concentration of cystatin C was normal, but the serum concentration of creatinine measured with high-performance liquid chromatography method was elevated to a degree consistent with the serum creatinine concentration measured with enzymatic method. Accordingly, we predicted the possibility that creatinine contained in Decadron as a buffer was included in the measurement of his intrinsic serum creatinine. To test this hypothesis, the creatinine concentration of serum samples from another patient with known amounts of added Decadron were measured, and the additive effect of the extrinsic creatinine in the measurement of serum creatinine concentration was confirmed. These findings clearly suggest that we should consider the influence of extrinsic creatinine as an inactive ingredient in the measurement of serum creatinine.
21361817 Online self-management in rheumatoid arthritis: a patient-centered model application. 2011 Mar OBJECTIVE: The aim of this study was to describe the online transformation of an empirically validated, clinic-based, self-management (SM) program for rheumatoid arthritis. MATERIALS AND METHODS: A cognitive-behavioral framework served as the theoretical basis for the intervention. As with the clinic-based approach, the psychoeducational program included educational modules, weekly homework assignments, and self-evaluation. The dynamic online environment included secure communication tools to support a virtual community for the participants to garner peer support. In addition to peer support, weekly follow-up support was provided by a trained clinician via telephone. We describe the process and structure of the online self-management (OSM) intervention. Administrative issues including clinical monitoring and management, data collection, and security safeguards are considered. Utilization and management data are provided and explored for 33 initial subjects. RESULTS: Individuals who volunteer to participate in an online modality are eager to receive this home-based programming. They readily engaged with all aspects of the OSM program and experienced few difficulties navigating the environment. CONCLUSION: An OSM site provides a convenient, effective, and securely maintained health service, once restricted to clinic settings. The OSM application can be used to extend the benefits of SM programs to broad target audiences and serves as a model for the emerging generation of Internet-based clinical management/delivery systems.
23399970 Imaging Atherosclerosis by Carotid Intima-media Thickness in vivo: How to, Where and in Wh 2012 Jun Carotid intima-media thickness (CIMT) can be reliably determined in vivo by carotidian ultrasound and is an accessible and reliable method to assess subclinical atherosclerosis. Available epidemiological data showed that CIMT is significantly correlated with future cardiovascular events. However it has limited value to help risk stratification on top of standard risk-derived functions such as Framingham risk score. It is particularly useful in individuals classified as being at intermediate or high risk by the presence of multiple conventional risk factors.CIMT HAS A CLASS IIA (LOE: B) reccommendation for cardiovascular risk assessment according to the practice guidelines published in 2010, emphasizing the presence of high risk if the common carotid artery intima-media thickness is above the 75(th) percentile. There is no indication to measure IMT in patients with full-blown atherosclerotic carotid disease, although carotidian ultrasound still remains a very useful tool to assess the severity of disease even in these subjects.Progression of CIMT (also associated with increasing age) can be delayed by some drugs (statins, colestipol and niacin) and by risk factors modification. However, there is no consistent data demonstrating a link between progression of CIMT and coronary and cerebral events. Subsequently, studies using CIMT progression as primary outcome to indicate the influence of a certain therapy on cardiovascular risk are inherently misleading as suggested in the recently published ACC/AHA Guidelines.
22143415 Methylene tetrahydrofolate reductase gene polymorphisms and their association with methotr 2012 Feb OBJECTIVE: A systematic review and a meta-analysis were conducted, to investigate the possible association of methylene tetrahydrofolate reductase (MTHFR) gene polymorphisms with adverse effects related to methotrexate (MTX). METHODS: A systematic literature search in PubMed retrieved a total of 44 studies (42 unique articles). Two polymorphisms were included in the meta-analysis: C677T and A1298C. Random effect models were used in the analysis. Odds ratios along with their 95% confidence intervals were computed to compare the distribution of alleles and genotypes between cases and controls. RESULTS: The analysis highlighted a significant association of C677T polymorphism with overall MTX toxicity, hepatotoxicity, hematological toxicity, and neurotoxicity. It also revealed an association with MTX toxicity in patients with rheumatoid arthritis. In contrast, a protective effect of C677T MTHFR polymorphism on acute graft-versus-host disease and on patients treated with hematopoietic cell transplantation was found. As for the A1298C polymorphism, a statistically significant association with overall MTX toxicity and a protective role of the polymorphism in rheumatoid arthritis patients was detected. CONCLUSION: These results indicate the association of MTHFR polymorphisms with MTX toxicity. However, further studies are needed to reveal the underlying biological mechanism of the association.
21970314 Severe sepsis caused by Aeromonas hydrophila in a patient using tocilizumab: a case report 2011 Oct 5 INTRODUCTION: Aeromonas species do not commonly cause disease in humans. However, when disease is seen, it often occurs in patients with underlying immunosuppression or malignancy and has a high fatality rate. CASE PRESENTATION: A 72-year-old Japanese woman with rheumatoid arthritis treated with tocilizumab (which has an immunosuppressive effect) presented with severe epigastric pain. She had a fever with chills, hypotension and jaundice. She was diagnosed with acute suppurative cholangitis and treated with cefoperazone-sulbactam and an endoscopic drainage was performed. Jaundice was slightly improved, but the shock state and inflammatory reactions were prolonged as typical of septic shock. On the second day after admission, an electrocardiogram showed ST segment elevation and echocardiography showed ventricular wall dysfunction. Coronary arteries were patent in coronary angiography and she was diagnosed with stress-induced cardiomyopathy. Blood cultures showed Aeromonas hydrophila. A stool culture was negative for A. hydrophila. On day six, her white blood cell count and neutrophils were normalized and cefoperazone-sulbactam treatment was halted. Left ventricular function normalized on day twelve and a laparoscopic cholecystectomy for cholelithiasis was performed on the 16th day of hospitalization. A culture from the bile showed A. hydrophila. Eighteen days after surgery, tocilizumab treatment was restarted and there were no complications. Two months after restarting tocilizumab, our patient is stable without any serious events. CONCLUSION: We present a rare case of A. hydrophila sepsis and acute suppurative cholangitis in an elderly patient with gallstones and rheumatoid arthritis using tocilizumab. This clinical course may suggest that preemptive treatment for cholelithiasis prior to using molecular-targeting agents might be feasible in elderly patients.
21999586 The neuropsychological profile of infantile Duchenne muscular dystrophy. 2011 Nov It has been shown that children with Duchenne muscular dystrophy (DMD) exhibit specific cognitive deficits. However, the neuropsychological profile has not yet been fully characterized. In order to control for the contribution of motor impairments as a confounding variable that is usually present when assessing children with muscular pathologies, we compared children with DMD to a group of children with an autoimmune pathology that does not entail either brain or cognitive dysfunction but does imply motor impairment: juvenile rheumatoid arthritis (JRA). An extensive neuropsychological evaluation was administered, including intelligence, perception, language, memory and learning, attention, executive function, praxis and reasoning. As the main result, in children with DMD we found significantly lower performances in verbal IQ, verbal short-term memory and phonological abilities, as well as in praxis and executive functioning domains. A wide range of cognitive domains, including verbal abilities, executive functioning, and praxis, must be taken into account when assessing neuropsychological functioning in children with DMD. In particular, subtle executive function impairment could be considered as a subclinical marker of cognitive impairment in developmental disorders.
22662593 Hepatitis C virus infection associated arthritis. 2012 Apr Hepatitis C-related arthropathy is one of the most common extra hepatic manifestations (EHMs) of HCV that may resemble rheumatoid arthritis (RA). Although symptoms can be disabling, prognosis typically is benign. The frequency and pattern of arthritis associated with chronic HCV patients and differentiation from RA was clinically, radiologically and laboratory studied. The study was carried out on two groups: GI: 100 patients diagnosed as RA according to the American College of Rheumatologist (ACR) and GII 100 chronic HCV patients. All patients underwent detailed history and complete general and locomotors examination. Complete blood picture (CBC), erythrocyte sedimentation rate (ESR), C reactive protein (CRP) and liver functions tests. HCV-RNA was done by HCV-RNA/RT-PCR. Anti-cyclic citrullinated peptide (Anti-CCP) antibody and rheumatoid factor (RF-IgM) was estimated by ELISA. Cryoglobulin were done to all patients. Plain X-rays for hands, wrists or knee were obtained on chronic HCV patients who had articular involvement at the time of anti-CCP antibody analysis. 17% GII had articular manifestations as 76.5% of them were polyarticular, while the remaining was monoarticular that associated with cryoglobulinemia. RF-IgM was 79% & 64.7% GI and HCV patients with articular manifestation (GII-A) respectively with no statistical significance. Anti-CCP was75 % and 11.7% positive of GI and GII-A respectively which was statistically significant. Cryoglobulinemia was positive in 15 % and 23.5% G1 and GII-A with no statistical significance.
22906004 Management of temporomandibular joint arthritis in adult rheumatology practices: a survey 2012 Aug 20 BACKGROUND: The temporomandibular (TMJ) is frequently involved in juvenile idiopathic arthritis (JIA), however little is known about management of this joint once a patient transitions from pediatric to adult care and about how rheumatologists approach TMJ involvement in rheumatoid arthritis (RA). The objective of this project was to describe adult rheumatologists' approaches to the diagnosis and treatment of TMJ arthritis in adults with JIA or RA. FINDINGS: One hundred and eighteen rheumatologists responded to an online survey of adult rheumatologists in the United States and Canada. Respondents estimated that 1-25% of their patients with RA or JIA had TMJ arthritis. Respondents reported lower rates of MRI use (19%) and higher rates of use of splinting/functional devices (50%) than anticipated. Approximately 80% of respondents reported that their practice had a standardized approach to the evaluation of patients with TMJ arthritis. The most commonly used medical therapies were non-steroid anti-inflammatory drugs, anti-tumor necrosis factor alpha medications, and methotrexate. CONCLUSIONS: Despite the majority of respondents stating that their practices had a standardized approach to the diagnosis and treatment of TMJ disease, there nevertheless appeared to be a range of practices reported. Standardizing the evaluation and treatment of TMJ arthritis across practices may benefit both adult and pediatric patients.
24991313 Trends in biologic therapies for rheumatoid arthritis: results from a survey of payers and 2012 Mar BACKGROUND: Advances in therapies for rheumatoid arthritis (RA), particularly biologics, have transformed the treatment paradigm for RA. However, the associated costs of these therapies result in a significant economic burden on the healthcare system. As a chronic disease requiring lifelong treatment, most health plans now position RA drugs as a high-priority therapeutic category. OBJECTIVE: To identify provider and payer practices and perceptions regarding coverage of RA biologics in the current marketplace, as well as emerging trends in reimbursement practices. METHOD: In November 2011, Reimbursement Intelligence, a healthcare research company, collected and analyzed quantitative and qualitative data via parallel-structure online surveys of 100 rheumatologists and 50 health plan payers (medical and pharmacy directors) who represent more than 80 million covered lives. The surveys included approximately 150 questions, and the surveys were designed to force a response for each question. RESULTS: Payers reported using tier placement, prior authorization, and contracting in determining coverage strategies for RA biologics. Among providers, experience with older RA agents remains the key driver for the choice of a biologic agent. A majority of payers and providers (68% and 54%, respectively) reported that they did not anticipate a change in the way their plans would manage biologics over the next 2 to 4 years. Payers' responses indicated uncertainty about how therapeutic positioning of newer, small-molecule drugs at price parity to biologics would affect the current reimbursement landscape. Survey responses show that approval of an indication for early treatment of RA is not likely to change the prescribing and reimbursement landscape for RA biologics. This survey further shows that payers and providers are generally aligned in terms of perceptions of current and future treatments for RA. CONCLUSION: Advances in RA therapies allow patients increasing options for effective disease management. However, the high cost of biologic therapies and the need for lifelong treatment raise economic concerns. Payer satisfaction with current therapies and uncertainty about added value of new therapies will create challenges for new medications coming to market.
21696640 Discrete derivative: a data slicing algorithm for exploration of sharing biological networ 2011 Jun 23 BACKGROUND: One important concept in traditional Chinese medicine (TCM) is "treating different diseases with the same therapy". In TCM practice, some patients with Rheumatoid Arthritis (RA) and some other patients with Coronary Heart Disease (CHD) can be treated with similar therapies. This suggests that there might be something commonly existed between RA and CHD, for example, biological networks or biological basis. As the amount of biomedical data in leading databases (i.e., PubMed, SinoMed, etc.) is growing at an exponential rate, it might be possible to get something interesting and meaningful through the techniques developed in data mining. RESULTS: Based on the large data sets of Western medicine literature (PubMed) and traditional Chinese medicine literature (SinoMed), by applying data slicing algorithm in text mining, we retrieved some simple and meaningful networks. The Chinese herbs used in treatment of both RA and CHD, might affect the commonly existed networks between RA and CHD. This might support the TCM concept of treating different diseases with the same therapy. CONCLUSIONS: First, the data mining results might show the positive answer that there are biological basis/networks commonly existed in both RA and CHD. Second, there are basic Chinese herbs used in the treatment of both RA and CHD. Third, these commonly existed networks might be affected by the basic Chinese herbs. Forth, discrete derivative, the data slicing algorithm is feasible in mining out useful data from literature of PubMed and SinoMed.
23289081 Estimating the burden of rheumatoid arthritis in Africa: A systematic analysis. 2012 Dec BACKGROUND: Rheumatoid arthritis (RA) has an estimated worldwide prevalence of 1%. It is one of the leading causes of chronic morbidity in the developed world, but little is known about the disease burden in Africa. RA is often seen as a minor health problem and has been neglected in research and resource allocation throughout Africa despite potentially fatal systemic manifestations. This review aims to identify all relevant epidemiological literature pertaining to the occurrence of RA in Africa and calculate the prevalence and burden of disease. METHODS: A systematic literature review of Medline, Embase and Global Health Library retrieved a total of 335 publications, of which 10 population studies and 11 hospital studies met pre-defined minimum criteria for relevance and quality. Data on prevalence was extracted, analysed and compared between population and hospital studies. Differences between genders were also analysed. FINDINGS: The estimated crude prevalence of RA in Africa based on the available studies was 0.36% in 1990, which translates to a burden of 2.3 million affected individuals in 1990. Projections for the African population in 2010 based on the same prevalence rates would suggest a crude prevalence of 0.42% and the burden increased to 4.3 million. Only 2 population studies have been conducted after 1990, so projections for 2010 are uncertain. Hospital-based studies under-report the prevalence by about 6 times in comparison to population-based studies. CONCLUSION: The availability of epidemiological information on RA in Africa is very limited. More studies need to be conducted to estimate the true burden and patterns of RA before appropriate health policies can be developed.
23028407 c-Jun N-Terminal Kinase in Inflammation and Rheumatic Diseases. 2012 The c-Jun N-terminal kinases (JNKs) are members of the mitogen-activated protein kinase (MAPK) family and are activated by environmental stress. JNK is also activated by proinflammatory cytokines, such as TNF and IL-1, and Toll-like receptor ligands. This pathway, therefore, can act as a critical convergence point in immune system signaling for both adaptive and innate responses. Like other MAPKs, the JNKs are activated via the sequential activation of protein kinases that includes two dual-specificity MAP kinase kinases (MKK4 and MKK7) and multiple MAP kinase kinase kinases. MAPKs, including JNKs, can be deactivated by a specialized group of phosphatases, called MAP kinase phosphatases. JNK phosphorylates and regulates the activity of transcription factors other than c-Jun, including ATF2, Elk-1, p53 and c-Myc and non-transcription factors, such as members of the Bcl-2 family. The pathway plays a critical role in cell proliferation, apoptosis, angiogenesis and migration. In this review, an overview of the functions that are related to rheumatic diseases is presented. In addition, some diseases in which JNK participates will be highlighted.
23002160 Influence of FCGR3A genotype on the therapeutic response to rituximab in rheumatoid arthri 2012 OBJECTIVES: To determine whether a polymorphism in the Fcγ receptor type IIIA (FCGR3A-F158V), influencing immunoglobulin G binding affinity, relates to the therapeutic efficacy of rituximab in rheumatoid arthritis (RA) patients. DESIGN: Observational cohort study. SETTING: Three university hospital rheumatology units in Sweden. PARTICIPANTS: Patients with established RA (n=177; 145 females and 32 males) who started rituximab (Mabthera) as part of routine care. PRIMARY OUTCOME MEASURES: Response to rituximab therapy in relation to FCGR3A genotype, including stratification for sex. RESULTS: The frequency of responders differed significantly across FCGR3A genotypes (p=0.017 in a 3×2 contingency table). Heterozygous patients showed the highest response rate at 83%, as compared with patients carrying 158FF (68%) or 158VV (56%) (p=0.028 and 0.016, respectively). Among 158VV patients, response rates differed between male and female patients (p=0.036), but not among 158FF or 158VF patients (p=0.72 and 0.46, respectively). CONCLUSIONS: Therapeutic efficacy of rituximab in RA patients is influenced by FCGR3A genotype, with the highest response rates found among heterozygous patients. This may suggest that different rituximab mechanisms of action in RA are optimally balanced in FCGR3A-158VF patients. Similar to the previously described associations with RA susceptibility and disease course, the impact of 158VV on rituximab response may be influenced by sex.
22844292 Markers of treatment response to methotrexate in rheumatoid arthritis: where do we stand? 2012 Methotrexate (MTX) is the most commonly used disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). However, despite its efficacy and affordability, additional DMARDs or biologic agents are often required in order to achieve the recommended goals of low disease activity or remission. Although well tolerated by most, some patients develop important side effects such as cytopenias, gastrointestinal adverse events (stomatitis, nausea), or abnormal liver function tests, which may limit its use and may result in additional health care costs. Given the clinical implications of widespread use of MTX in RA, various studies have evaluated the role of potential biomarkers in predicting treatment effectiveness of MTX. These biomarkers include RBC MTX polyglutamate (PG) levels; genetic variation in genes from relevant biological and metabolic pathways; gene expression profiles; serum proteins. This paper provides an update on the current data regarding biomarkers of treatment response to MTX.
24977078 Bacterial findings in infected hip joint replacements in patients with rheumatoid arthriti 2012 High rates of Staphylococcus aureus are reported in prosthetic joint infection (PJI) in rheumatoid arthritis (RA). RA patients are considered to have a high risk of infection with bacteria of potentially oral or dental origin. One thousand four hundred forty-three revisions for infection were reported to the Norwegian Arthroplasty Register (NAR) from 1987 to 2007. For this study 269 infection episodes in 255 OA patients served as control group. In the NAR we identified 49 infection episodes in 37 RA patients from 1987 to 2009. The RA patients were, on average, 10 years younger than the OA patients and there were more females (70% versus 54%). We found no differences in the bacterial findings in RA and OA. A tendency towards a higher frequency of Staphylococcus aureus (18% versus 11%) causing PJI was found in the RA patients compared to OA. There were no bacteria of potential odontogenic origin found in the RA patients, while we found 4% in OA. The bacteria identified in revisions for infection in THRs in patients with RA did not significantly differ from those in OA. Bacteria of oral or dental origin were not found in infected hip joint replacements in RA.
22132849 Postoperative eyelid infection in a patient taking etanercept. 2011 Dec Postoperative eyelid infections are a rare complication of eyelid surgery. The authors present a case of an eyelid infection occurring within the first week following surgery in a patient taking etanercept--a biologic anti-TNF-α agent used in the treatment of rheumatoid arthritis. The authors urge caution regarding the use of steroid/antibiotic combination ointments and systemic steroids in patients undergoing elective eyelid surgery who are on such medications. Perioperative discontinuation of etanercept in consultation with the prescribing physician may also be considered. Eyelid infections following eyelid surgeries such as blepharoplasty and ptosis correction are uncommon.( 1 , 2 ) A review of a large series of blepharoplasty procedures estimated the rate of postoperative infection at 0.2%.( 3 ) However, patients who are relatively immunosuppressed may be at a higher risk of developing skin and eyelid infections. We present a case of postoperative infection in a patient who was taking etanercept (Enbrel, Immunex Corporation, Thousand Oaks, CA) for rheumatoid arthritis.