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Treatment with etanercept of autoimmune hepatitis associated with rheumatoid arthritis: an open label proof of concept study
  1. Gwendoline Toulemonde1,
  2. Jean-Yves Scoazec2,
  3. Pierre Miossec1
  1. 1Department of Clinical Immunology and Rheumatology, Edouard Herriot hospital, University of Lyon, Lyon, France
  2. 2Department of Pathology, Edouard Herriot hospital, University of Lyon , Lyon, France
  1. Correspondence to Professor Pierre Miossec, Departments of Clinical Immunology and Rheumatology, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France; miossec{at}univ-lyon1.fr

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Rheumatoid arthritis (RA) is a systemic disease, with extra-articular manifestations,1 including inflammatory liver disease.2 3 Our recent results indicate that elevated transaminase levels in RA patients on methotrexate (MTX) are rarely related to MTX-specific liver lesions (5%), but frequently to autoimmune hepatitis (AIH) histological lesions (41%).2 4 We have previously found that inhibition of tumour necrosis factor (TNF) with etanercept was well tolerated in patients with arthritis and hepatitis C virus infection.5 Since TNFα inhibition can control RA joint disease, we asked the question of a possible positive effect of TNFα inhibitors on RA-associated liver disease.

The objective of this proof of concept study was to evaluate the effect of 6 months of etanercept treatment on RA-associated AIH histological lesions.

Among a population of 1571 patients treated with MTX for chronic arthritis, 53 with persistent abnormal transaminase levels …

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