Régent Alexis, Mouthon Luc
UPRES EA 4058, Université Paris Descartes, Faculté de Médecine, F-75005 Paris, France.
Presse Med. 2009 May;38(5):761-73. doi: 10.1016/j.lpm.2009.02.006. Epub 2009 Apr 5.
TNFalpha plays a crucial role in the physiopathology of a large number of auto-immune and/or inflammatory systemic diseases. In addition to authorized indications including rheumatoid arthritis, ankylosing spondylitis, Crohn disease, ulcerative colitis, psoriatic arthritis and plaque psoriasis, TNFalpha blockers have been tested in a wide range of auto-immune and/or inflammatory diseases. TNFalpha blockers might be an option in refractory ANCA-associated vasculitis, sarcoïdosis, adult onset Still disease, Behçet disease, AA amyloïdosis and TRAPS. However, pertaining to the limited number of prospective randomized trails available, the small number of patients included and the poor methodology, it is difficult to define their place in the therapeutic strategy in these conditions. The therapeutic effect of TNFalpha blockers is often suspensive and disease flares are frequently observed during sustained treatment, as in the case of Behçet's disease. Published data do not support the use of TNFalpha blockers in connective tissue diseases.
肿瘤坏死因子α（TNFα）在大量自身免疫性和/或炎症性全身性疾病的病理生理过程中起着关键作用。除了已获批的适应症，包括类风湿性关节炎、强直性脊柱炎、克罗恩病、溃疡性结肠炎、银屑病关节炎和斑块状银屑病外，TNFα阻滞剂还在多种自身免疫性和/或炎症性疾病中进行了试验。TNFα阻滞剂可能是难治性抗中性粒细胞胞浆抗体（ANCA）相关血管炎、结节病、成人斯蒂尔病、白塞病、AA型淀粉样变性和肿瘤坏死因子受体相关周期性综合征（TRAPS）的一种治疗选择。然而，鉴于可用的前瞻性随机试验数量有限、纳入患者数量少且方法欠佳，很难确定它们在这些疾病治疗策略中的地位。TNFα阻滞剂的治疗效果往往是暂时的，并且在持续治疗期间经常观察到疾病复发，如白塞病的情况。已发表的数据不支持在结缔组织疾病中使用TNFα阻滞剂。
