Anti-tumor necrosis factor (TNF) treatment is effective for treating rheumatoid arthritis patients with refractory systemic rheumatoid vasculitis (SRV), according to a report in the June issue of the Annals of the Rheumatic Diseases.
TNF plays a key role in the pathophysiology of SRV, the authors explain, and case reports of anti-TNF therapy for SRV have been encouraging.
Dr. X. Puechal from Le Mans General Hospital, France and colleagues assessed the value of anti-TNF agents as second-line treatment in nine patients with SRV refractory to cyclophosphamide and glucocorticoids.
Six of the nine patients achieved remission (5 complete, 1 partial) after a mean of 28.6 weeks of anti-TNF therapy, the authors report. One patient failed to achieve remission, and two patients withdrew from treatment because of side effects.
Two patients experienced four cutaneous relapses -- three during anti-TNF treatment and one after withdrawal of treatment for complete remission. All relapses remitted after reintroduction or increased frequency of anti-TNF treatment.
Infections requiring interruption of treatment occurred in three patients.
Eight patients were still alive and five were still being treated with the initial anti-TNF agent after a mean total follow-up of 32.6 months, the researchers note.
The mean prednisone dose declined from 50.6 mg/day to 8.1 mg/day with anti-TNF treatment.
"This study provides evidence of efficacy of anti-TNF therapy in adjunct to glucocorticoids for treating active refractory SRV after the failure of conventional therapy, including cyclophosphamide and high-dose glucocorticoids," the authors conclude, "although there is a high risk of infection in these severely ill patients."
Ann Rheum Dis 2008;67:880-884.
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