RESEARCH - Anti-TNF-alpha therapy in RA and autoimmunity

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Rheumatol Int. 2006 Jan;26(3):209-14. Epub 2004 Dec 31.

Anti-TNFalpha therapy in rheumatoid arthritis and autoimmunity.

Dipartimento di Medicina Clinica e Sperimentale, Universita di Verona,

Verona, Italy. paola.caramaschi@...

The aim of the study was to evaluate a panel of autoantibodies in patients

affected by rheumatoid arthritis (RA) treated with anti-TNFalpha blockers,

and to consider a different autoantibody induction effect by infliximab and

etanercept; and in addition to evaluate in these cases a relationship

between antinuclear antibody (ANA) titre and both C-reactive protein (CRP)

and Blys levels. Fifty-four patients (8 men, 46 women, mean age 51.4 years,

mean duration of disease 13.6 years) affected by refractory RA were treated

with anti-TNFalpha blockers for 12 consecutive months; 43 patients were

given infliximab and 11 etanercept. At baseline and every 4 months a panel

of autoantibodies consisting of rheumatoid factor, antinuclear,

anti-double-stranded DNA, anti-ENA, anti-mitochondrial, anti-thyroid and

anti-neutrophil cytoplasmic antibodies (ANCA) was tested. At the same time

CRP level was measured. Blys level was determined at baseline and after 1

year in five cases that developed a strong positivity for ANA during

infliximab therapy. In 41 cases (95.3%) treated with infliximab, ANA were

detected on at least one occasion, and in almost half of these cases the

titre was very high, equal to or higher than 1:1.280. On the other hand,

patients treated with etanercept presented ANA positivity in a lower

percentage of cases and at a low titre. No correlation was found between ANA

titre and CRP level; Blys level did not present a constant trend in patients

who developed a very high positivity for ANA. Anti-double-stranded DNA,

anti-thyroid or ANCA were found only in a few patients, in the absence of a

clinical picture indicative of systemic lupus erythematosus, autoimmune

thyroiditis or ANCA-associated vasculitis. A different incidence of ANA

positivity was found in infliximab- and etanercept-treated RA patients; this

finding might be due to the partially different method of inhibition of

TNFalpha between the two drugs. Both CRP and Blys do not seem to participate

in this phenomenon. Other autoantibodies were detected in a few patients,

but no case of onset of new autoimmune disorders was observed.

PMID: 15627197

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=15627197

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