1568-9972/$ - see front matter D 2004 Elsevier B.V. All rights reserved.
Lecture: bTNF-a inhibitors in systemic vasculitides and connective tissue diseasesQ, Carol-Nachman symposium, Wiesbaden, Germany,
Saturday, May 08, 2004.
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TNF-a inhibitors in systemic vasculitides and
connective tissue diseases
Department of Rheumatology, University Hospital of Schleswig-Holstein, Campus Luebeck, and Rheumaklinik Bad Bramstedt,
Ratzeburger Allee 160, 23538 Luebeck, Germany
Received 14 May 2004; accepted 3 June 2004
Available online 21 July 2004
The introduction of TNF-a inhibitors in the treatment of rheumatoid arthritis and several other diseases meant a major
progress in the management and to the understanding of these chronic inflammatory diseases. In this article, the evidence of
the role of TNF-a and for TNF-a inhibitors in systemic vasculitides and connective tissue diseases is reviewed. TNF-a is
expressed in inflammatory lesions. TNF-a acts as a proinflammatory cytokine in most disease processes analyzed so far, but
it might have anti-inflammatory properties under certain conditions as well, e.g. with respect to B-cell regulation in systemic
lupus erythematosus. It is not clear to what extent such aspects will be important in the treatment of connective tissue
diseases and systemic vasculitides with TNF-a inhibitors. So far, most case reports and case series have suggested
favourable results with TNF-a inhibitor therapy in systemic lupus erythematosus, dermato- and polymyositis, giant cell
arteritis, Churg–Strauss syndrome, Wegener’s granulomatosis and microscopic polyangiitis. Results of randomized, placebo-
controlled trials are awaited for several connective tissue diseases and systemic vasculitides. One randomized, placebo-
controlled trial has found no efficacy of infliximab treatment in primary Sjfgren’s syndrome recently.
D 2004 Elsevier B.V. All rights reserved.
Keywords: TNF-a; TNF-a inhibitor; Infliximab; Etanercept; Connective tissue disease; Systemic vasculitis
Autoimmunity Reviews 4 (2005) 28 – 34