Thirion L, Picard D, Mejjad O, Courville P, Le Loet X, Joly P
Clinique Dermatologique, CHU de Rouen.
Ann Dermatol Venereol. 2006 May;133(5 Pt 1):453-5. doi: 10.1016/s0151-9638(06)70938-3.
Anti-TNFalpha has occasionally been used in the treatment of recalcitrant forms of systemic vasculitis such as Behçet's disease, Wegener's granulomatosis and Churg-Strauss syndrome. We report on the outcome of treatment in rheumatoid arthritis patients with cutaneous vasculitis lesions on anti-TNFalpha.
Two patients with rheumatoid arthritis present for several years had necrotic ulcers of the lower limbs due to cutaneous vasculitis. After the failure of various immunosuppressive drugs (cyclophosphamide, azathioprine, methotrexate), the two patients were treated with anti-TNFalpha: infliximab in the first case and adalimumab in the second. Cutaneous ulcers healed within two to four months of the start of anti-TNFalpha treatment. Despite ongoing anti-TNFalpha treatment, these cutaneous ulcers relapsed four to six months after complete healing.
Initially spectacular healing of cutaneous vasculitis ulcers under anti-TNF alpha treatment followed by relapse after several months of treatment is suggestive of an escape mechanism.
抗TNFα偶尔用于治疗难治性系统性血管炎，如白塞病、韦格纳肉芽肿病和变应性肉芽肿性血管炎。我们报告类风湿关节炎患者抗TNFα治疗伴发皮肤血管炎病变的治疗结果。
两名患类风湿关节炎数年的患者因皮肤血管炎出现下肢坏死性溃疡。在多种免疫抑制药物（环磷酰胺、硫唑嘌呤、甲氨蝶呤）治疗失败后，这两名患者接受了抗TNFα治疗：第一例用英夫利昔单抗，第二例用阿达木单抗。抗TNFα治疗开始后两到四个月，皮肤溃疡愈合。尽管持续进行抗TNFα治疗，但这些皮肤溃疡在完全愈合后四到六个月复发。
抗TNFα治疗下皮肤血管炎溃疡最初愈合显著，但治疗数月后复发，提示存在逃逸机制。
