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True infliximab resistance in rheumatoid arthritis: a role for lymphotoxin α?

Buch, M.H., Conaghan, P., Quinn, M.A., Bingham, S.J., Veale, D. and Emery, P. (2004) True infliximab resistance in rheumatoid arthritis: a role for lymphotoxin α? Annals of the Rheumatic Diseases, 63 (10). pp. 1344-1346. ISSN 0003-4967

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Background: The combination of methotrexate and the anti-tumour necrosis factor (TNF) antibody infliximab is a very effective treatment for rheumatoid arthritis (RA). However, a proportion of patients are not responsive to this treatment. Inefficacy may represent a TNF independent disease or insufficient drug at the site of action.

Case report: A patient with RA resistant to repeated high dose infliximab infusions and intra-articular infliximab into an inflamed knee is described. No beneficial clinical effect was observed. Pre-injection arthroscopic biopsy of the study knee demonstrated TNF staining but also confirmed the presence of lymphotoxin (LT or TNFß) on immunohistochemistry. Subsequent treatment with etanercept (which blocks LT as well as TNF) resulted in clinical remission of disease.

Conclusion: This case suggests that resistance to TNF blockade may occur when TNF is not the dominant inflammatory cytokine and suggests that LT may have a pathogenic role in RA.

Item Type: Article
Copyright, Publisher and Additional Information: Copyright © 2004 BMJ Publishing Group Ltd & European League Against Rheumatism. Reproduced in accordance with the publisher's self-archiving policy.
Keywords: rheumatoid arthritis, anti-tumour necrosis factor, infliximab, lymphotoxin α
Institution: The University of Leeds
Academic Units: The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Molecular Medicine (LIMM) (Leeds) > Section of Musculoskeletal Disease (Leeds)
Depositing User: Repository Assistant
Date Deposited: 14 Aug 2006
Last Modified: 04 Jun 2014 10:17
Published Version: http://dx.doi.org/10.1136/ard.2003.014878
Status: Published
Publisher: BMJ
Refereed: Yes
Identification Number: 10.1136/ard.2003.014878
URI: http://eprints.whiterose.ac.uk/id/eprint/1487

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