Spadaro Antonio, Scrivo Rossana, Riccieri Valeria, Valesini Guido
Dipartimento di Clinica e Terapia Medica - Divisione di Reumatologia, Sapienza Università di Roma, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161 Roma, Italy.
Joint Bone Spine. 2008 Jan;75(1):87-9. doi: 10.1016/j.jbspin.2007.03.003. Epub 2007 Aug 28.
The proinflammatory cytokine tumor necrosis factor alpha seems to play a major role in the pathogenesis of both rheumatoid arthritis and primary biliary cirrhosis. We describe the case of a 46-year-old female patient with rheumatoid arthritis and concomitant primary biliary cirrhosis treated with anti-tumor necrosis factor alpha agents. During infliximab treatment we observed a poor clinical response and persistence of liver function test abnormalities. After infliximab interruption the levels of alkaline phosphatase dropped and had nearly reached normal values when etanercept was started. This new therapeutic regimen was well tolerated with joint clinical improvement and normalization of alkaline phosphatase. This single case shows that etanercept therapy maintained liver enzymes within the normal range and controlled the arthritis with a 30-month follow-up whereas infliximab did not account for similar results.
促炎细胞因子肿瘤坏死因子α似乎在类风湿性关节炎和原发性胆汁性肝硬化的发病机制中都起着重要作用。我们描述了一名46岁患有类风湿性关节炎并伴有原发性胆汁性肝硬化的女性患者，该患者接受了抗肿瘤坏死因子α药物治疗。在英夫利昔单抗治疗期间，我们观察到临床反应不佳且肝功能检查异常持续存在。英夫利昔单抗中断后，碱性磷酸酶水平下降，当开始使用依那西普时，其水平已接近正常。这种新的治疗方案耐受性良好，关节症状临床改善，碱性磷酸酶恢复正常。这一病例表明，在30个月的随访中，依那西普疗法使肝酶维持在正常范围内并控制了关节炎，而英夫利昔单抗则未取得类似结果。
