Case Studies

 Case 7.3 Severe rheumatoid arthritis treated with anti-tumour necrosis factor alpha antibodies

A 55-year-old woman with active rheumatoid arthritis (RA) in her hands; histololoy showed typical pannus formation. This was previously unresponsive to multiple disease-modifying agents, she was treated with a humanized mouse monoclonal antibody to tumour necrosis factor alpha (anti-TNF-alpha) as part of a clinical trial. Following her first infusion of anti-TNF-alpha a significant reduction (60-70%) in clinical indices of inflammation (number of swollen and tender joints, duration of morning stiffness and pain score) and serum C-reactive protein was noted within 3 days. Unexpectedly, clinical and laboratory improvement was sustained for 12 weeks following the first infusion.

Anti-TNF-alpha therapy is a good example of immunotherapy specifically targeted at a key disease mediator. Since anti-TNF-alpha is not a cure, repeated infusions will be required for controlling active RA. International studies are underway to determine optimal frequency of treatment and examine possible synergy in combination with anti-CD4.