Article Text

other Versions

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


                        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

                        Statistics from

                        Request permissions

                        If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.