%0 Journal Article %A M H Buch %A P G Conaghan %A M A Quinn %A S J Bingham %A D Veale %A P Emery %T True infliximab resistance in rheumatoid arthritis: a role for lymphotoxin α? %D 2004 %R 10.1136/ard.2003.014878 %J Annals of the Rheumatic Diseases %P 1344-1346 %V 63 %N 10 %X Background: The combination of methotrexate and the anti-tumour necrosis factor α (TNFα) antibody infliximab is a very effective treatment for rheumatoid arthritis (RA). However, a proportion of patients are not responsive to this treatment. Inefficacy may represent a TNFα independent disease or insufficient drug at the site of action.Case report: A patient with RA resistant to repeated high dose infliximab infusions and intra-articular infliximab into an inflamed knee is described. No beneficial clinical effect was observed. Pre-injection arthroscopic biopsy of the study knee demonstrated TNFα staining but also confirmed the presence of lymphotoxin α (LTα or TNFβ) on immunohistochemistry. Subsequent treatment with etanercept (which blocks LTα as well as TNFα) resulted in clinical remission of disease.Conclusion: This case suggests that resistance to TNF blockade may occur when TNFα is not the dominant inflammatory cytokine and suggests that LTα may have a pathogenic role in RA. %U https://ard.bmj.com/content/annrheumdis/63/10/1344.full.pdf