The development of anti-tumor necrosis factor a (TNF-a) therapy has been a milestone in the treatment of rheumatoid arthritis and other inflammatory-mediated conditions, but their use has also been accompanied by new or aggravated forms of autoimmunity, making its use in SLE controversial. SLE is characterized by heterogeneity of clinical manifestations and a relapsing-remitting course. Despite a significant improvement in its prognosis and management, there are still significant unmet therapeutic needs. Therapeutic agents targeting pro-inflammatory cytokines are an interesting option. Several studies support a role for TNFa in the pathogenesis of the disease and therefore a potential benefit from inhibition. Serum TNFa levels and expression in renal and cutaneous biopsies are highly elevated in SLE patients and correlate with disease activity. Several open-label studies suggest that TNF blockade is effective in SLE patients with arthritis, nephritis and skin disease. Our long-term study of etanercept in refractory arthritis supports its efficacy in arthritis and also suggests a possible benefit in refractory pleuropericarditis. To sufficiently address the potential value of TNFa-blocking therapy in SLE, larger and controlled clinical trials are necessary in a near future.
Disclosure of Interest None declared