From the Guidelines
The patient on Enbrel (etanercept) for connective tissue disease with swollen, red legs should seek immediate medical attention as this could represent a serious adverse reaction to the medication or a complication of their underlying condition. The symptoms of leg swelling and erythema in a patient on their 3rd dose of Enbrel (etanercept) for connective tissue disease could be indicative of a serious infection, such as cellulitis, or a complication of their underlying condition, as TNF-alfa antagonists like etanercept carry warnings about infections, particularly granulomatous infections, such as tuberculosis, histoplasmosis, and coccidiomycosis 1.
Possible Causes and Considerations
- Infection: The patient should be screened for infections, as TNF-alfa antagonists can increase the risk of infections, particularly granulomatous infections 1.
- Deep vein thrombosis: The symptoms of leg swelling and erythema could also indicate deep vein thrombosis, which requires prompt medical attention.
- Exacerbation of connective tissue disease: The symptoms could be a sign of an exacerbation of the patient's underlying connective tissue disease, which would require adjustments to their immunosuppressive regimen.
Recommended Course of Action
The patient should not stop Enbrel without medical guidance but should contact their rheumatologist or go to the emergency department promptly. While awaiting medical care, the patient can elevate their legs above heart level to reduce swelling and avoid putting pressure on the affected areas. The healthcare provider will likely perform a physical examination, possibly order blood tests to check for infection markers, and may consider imaging studies like ultrasound to rule out blood clots. Treatment will depend on the diagnosis but might include antibiotics for infection, anticoagulants for blood clots, or adjustments to the immunosuppressive regimen if it's a disease flare or medication reaction.
From the Research
Possible Causes of Leg Swelling and Erythema
- Leg swelling and erythema in a patient on their 3rd dose of Enbrel (etanercept) for connective tissue disease may be related to the underlying disease itself, as connective tissue diseases can cause leg ulcers and swelling 2, 3
- Etanercept, a TNF-α inhibitor, is used to treat chronic inflammatory immune-mediated diseases, including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, but its use may not directly cause leg swelling and erythema 4, 5
- Leg swelling can have various etiologies, including systemic, superficial, and deep venous, and lymphatic disorders, and can occur bilaterally or unilaterally 6
Considerations for Etanercept Treatment
- Etanercept is generally well-tolerated, but its use may require screening tests for latent tuberculosis, hepatitis B virus, and hepatitis C virus before starting treatment 4
- TNF-α inhibitors, including etanercept, are contraindicated in patients with demyelinating diseases 4
Disease-Related Complications
- Connective tissue diseases, such as mixed connective tissue disease, can cause leg ulcers and swelling, which may be refractory to treatment 2, 3
- Leg ulcers in patients with connective tissue diseases may improve with treatment of underlying pulmonary arterial hypertension, such as with sitaxsentan 3