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Anti-tumour necrosis factor treatment in patients with refractory systemic vasculitis associated with rheumatoid arthritis
  1. X Puéchal1,
  2. C Miceli-Richard2,
  3. O Mejjad3,
  4. P Lafforgue4,
  5. C Marcelli5,
  6. E Solau-Gervais6,
  7. S Steinfeld7,
  8. C Villoutreix8,
  9. R Trèves9,
  10. X Mariette2,
  11. L Guillevin10,
  12. for the Club Rhumatismes et Inflammation (CRI)
  1. 1
    Department of Rheumatology, Le Mans General Hospital, Le Mans, France
  2. 2
    Department of Rheumatology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
  3. 3
    Department of Rheumatology, Rouen University Hospital, Rouen, France
  4. 4
    Department of Rheumatology, Marseille University Hospital, Marseille, France
  5. 5
    Department of Rheumatology, Caen University Hospital, Caen, France
  6. 6
    Department of Rheumatology, Lille University Hospital, Lille, France
  7. 7
    Department of Rheumatology, Erasme University Hospital, Brussels, Belgium
  8. 8
    Department of Rheumatology, Saint-Antoine University Hospital, Paris, France
  9. 9
    Department of Rheumatology, Limoges University Hospital, Limoges, France
  10. 10
    Department of Internal Medicine, Cochin University Hospital, Paris, France and the CRI (Club Rhumatismes et Inflammation)
  1. Dr X Puéchal, Service de Rhumatologie, Centre Hospitalier du Mans, 194 avenue Rubillard, 72000 Le Mans, France; xpuechal{at}


Objective: To assess anti-tumour necrosis factor (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 five, partial in one). 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.

Conclusions: 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.

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  • Funding: The CRI has received funding from Wyeth, Schering Plough, Abbott and Roche.

  • Competing interests: XM, XP and SS have been investigators of studies evaluating the role of anti-tumour necrosis factor therapy in rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis, which were partially funded by Immunex, Amgen and Abbott. XM, XP and SS have also been investigators of a study evaluating anti-tumour necrosis factor therapy in Sjögren syndrome, which was partially funded by Schering Plough.

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