Anti-tumour necrosis factor (anti-TNF) therapy of patients with rheumatoid arthritis dates back to 1992, when the first proof-of-principle trials were performed in London by Maini and Feldmann. Considerable studies of the mechanism of action were performed, and insights into the way in which anti-TNF therapy delivers its benefit were obtained. In this brief review, certain aspects of knowledge acquired and the many gaps will be reviewed. Focus will be on the TNF-dependent cytokine cascade and what it means, and potential new approaches to treatment. Finally, an entertaining challenge: might many or even all unmet clinical needs be dealt with through cytokine analysis?
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Funding Support from Arthritis Research Campaign, Kennedy Institute of Rheumatology Trustees, Trillium Therapeutics Inc, Nuon Therapeutics Inc, which is gratefully acknowledged.
Competing interests MF is a consultant and shareholder for Nuon (Tranilast) and consultant to Trillium (CD200Fc).
Provenance and Peer review Not commissioned; externally peer reviewed.
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