Resolution of ocular and mediastinal sarcoidosis after Janus kinase inhibitor therapy for concomitant rheumatoid arthritis

Granulomatous disease and the two faces of Janus: divergent effects of tofacitinib therapy for inflammatory arthritis

“…Over the ensuing year, corticosteroid requirements significantly decreased, and no further arthrocenteses were required. Patient 2 is the first report of sarcoid arthropathy responsive to tofacitinib, reaffirming benefit of JAK-inhibitors in sarcoidosis (3,4). JAK-mediated interferon-γ pathways are implicated in granuloma formation (5), and so the therapeutic potential of JAK-inhibitors is unsurprising.…”

“…Sirs, Janus kinases (JAKs) are intracellular tyrosine kinases utilised for signalling by extracellular receptors involved in many proinflammatory pathways like interferon-γ (1) and some anti-inflammatory pathways like interleukin-10 (2). JAK-inhibitors, already approved for various inflammatory conditions including rheumatoid arthritis (RA), also show promise for treating sarcoidosis (3,4). This communication contrasts two novel cases of patients treated with the JAK-inhibitor tofacitinib: a woman with RA developing granulomatous hepatitis during therapy and a man with intractable arthropathic and cutaneous sarcoidosis responding to treatment.…”

Sarcoidosis-Related Uveitis: A Review

“…We report an observation of paradoxical sarcoidosis panuveitis induced by adalimumab in the context of rheumatoid arthritis. Although the uveitis and inflammatory rheumatism remained active upon discontinuation of anti-TNFα, the ocular inflammation and mediastino-hilar adenopathy disappeared with tofacitinib treatment [169]. Tofacitinib is currently being tested in non-infectious uveitis (NCT03580343).…”