Is granulomatous mastitis a rheumatologic disease? The emerging role of rheumatologists in disease management.

Abstract

Granulomatous mastitis (GM) is a rare, chronic inflammatory breast disease characterized by non-caseating granulomas. While its etiology remains unclear, emerging evidence supports an immune-mediated pathogenesis with parallels to autoimmune rheumatic diseases. This review explores the inflammatory mechanisms underlying GM, emphasizing the roles of cytokines such as TNF-α, IL-6, and the Th17 axis in sustaining granulomatous inflammation. Traditional management has centered on surgical excision, but high recurrence rates have prompted a shift toward immunosuppressive therapy, particularly corticosteroids and disease-modifying antirheumatic drugs (DMARDs). Recent studies suggest that DMARDs offer effective disease control while minimizing the adverse effects of long-term steroid use. Given the autoimmune overlap and the efficacy of targeted immunomodulatory therapy, rheumatologists play an increasingly critical role in GM management. This review advocates for increased awareness of GM within the rheumatology community and underscores the need for further research to refine therapeutic strategies.