Treatment of refractory temporal arteritis with adalimumab

被引:45
作者
Ahmed, M. Mubashir
Mubashir, Eisha
Hayat, Samina
Fowler, Marjorie
Berney, Seth Mark
机构
[1] Louisiana State Univ, Hlth Sci Ctr, Ctr Excellence Arthrit & Rheumatol, Dept Med Div Rheumatol, Shreveport, LA 71130 USA
[2] Louisiana State Univ, Hlth Sci Ctr, Dept Pathol, Shreveport, LA 71130 USA
关键词
adalimumab; corticosteroids; giant cell arteritis; temporal arteritis; TNF-alpha inhibitors;
D O I
10.1007/s10067-006-0375-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
High-dose corticosteroids (CS) are the mainstay of treatment for temporal (giant cell) arteritis (TA). A usually required long-term treatment with CS, ranging from 1 to 5 years or more, frequently leads to serious side effects in about 60% of patients. There is no conclusive evidence about the role of immunosuppressive agents like methotrexate and azathioprine in the treatment of TA. There are few reports of treatment of refractory or steroid-dependent TA with tumor necrosis factor alpha (TNF-alpha) inhibitors including infliximab and etanercept. TA is characterized by infiltration of the vessel wall by macrophages, giant cells, and T lymphocytes, with production of several cytokines responsible for the acute phase response. TNF-alpha has been demonstrated in up to 60% of the cells in all areas of inflamed arteries by immunohistochemical techniques; hence, it could play a pivotal role in the pathogenesis of TA. We report the first case of resistant TA, which was treated successfully with adalimumab, a fully human recombinant IgG1, anti-TNF-alpha monoclonal antibody. The efficacy of TNF-alpha inhibitors in resistant TA should be studied in larger, controlled studies.
引用
收藏
页码:1353 / 1355
页数:3
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