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Anti-Tumor Necrosis Factor treatment in patients with refractory systemic vasculitis associated with rheumatoid arthritis.
  1. Xavier Puéchal (xpuechal{at}ch-lemans.fr)
  1. Centre Hospitalier du Mans, France
    1. Corinne Miceli-Richard (miceli.corinne{at}ch-lemans.fr)
    1. Hopital de Bicetre, France
      1. Othmane Mejjad (othmane.mejjad{at}ch-lemans.fr)
      1. University Hospital of Rouen, France
        1. Pierre Lafforgue (pierre.lafforgue{at}ch-lemans.fr)
        1. Hopital la Conception, France
          1. Christian Marcelli (marcelli-c{at}ch-lemans.fr)
          1. Caen University Hospital, France
            1. Elisabeth Solau-Gervais (e.solau{at}ch-lemans.fr)
            1. Poitiers University Hospital, France
              1. Serge Steinfeld (serge.steinfeld{at}ch-lemans.fr)
              1. Erasme University Hospital, Belgium
                1. Caroline Villoutreix (caroline.villoutreix{at}ch-lemans.fr)
                1. Paris University Hospital, France
                  1. Richard Trèves (richard.treves{at}ch-lemans.fr)
                  1. Limoges University Hospital, France
                    1. Xavier Mariette (xavier.mariette{at}ch-lemans.fr)
                    1. Service de Rhumatologie, France
                      1. Loïc Guillevin (loic.guillevin{at}ch-lemans.fr)
                      1. Hopital Cochin, France

                        Abstract

                        Objective: To assess anti-TNF agents in patients with refractory systemic rheumatoid vasculitis (SRV).

                        Methods: 1200 rheumatologists and internists were asked to provide medical files for patients with anti-TNF agents given as a second-line treatment for active SRV refractory to cyclophosphamide and glucocorticoids.

                        Results: We identified nine cases in which anti-TNF drugs were given for active SRV, despite previous treatment with a mean cumulative dose of 8.4 g of cyclophosphamide in association with high-dose glucocorticoids. The mean prednisone dose before anti-TNF therapy was 29.6 mg/day. After 6 months, six patients were in remission (complete in 5, partial in 1). The treatment failed in one patient and two patients stopped taking the anti-TNF treatment due to side effects. Mean prednisone dose was reduced to 11.2 mg/day. Severe infection occurred in three patients. Relapses were observed in two patients. Remission was re-established by reintroducing anti-TNF therapy in one case and increasing the dose in the other.

                        Conclusion:This study provides evidence of efficacy of anti-TNF therapy in adjunct to glucocorticoids for treating active refractory SRV. Remission was achieved in two thirds of patients, with a significant decrease in prednisone dose, although there was a high rate of infection in these severely ill patients.

                        • anti-TNF therapy
                        • rheumatoid arthritis
                        • systemic vasculitis

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