Biological therapy in inflammatory arthritis

Recently, a number of biologic agents have been tested as therapies forautoimmune diseases, revealing new insights into the pathogenesisof immune-mediated diseases that revolutionized the management ofsuch patients. In the present article, we report on biological therapymodalities in autoimmune diseases. These patients have beensuccessfully treated by these agents, so that a better knowledge ontheir management and the risks of harm has become part of goodclinical practice

A new interleukin to treat arthrites: anti-interleukin-6

Immunopathological aspects of interleukin-6 are analyzed, as well as the clinical use of tocilizumab, its safety and efficacy. Several studies have demonstrated that the blockade of interleukin-6 may bring a therapeutic benefit to rheumatoid arthritis patients. Tocilizumab is a humanized monoclonal antibody against the cell and soluble receptor of interleukin-6 and it also changes the levels of vascular endothelial growth  factor. Although its mechanism of action is not completely known to date various reports on medical literature show that its benefits are quite reliable and suggest that it will be a new anticitokine treatment for inflammatory arthritis

Rituximab (Mabthera), a new approach for the treatment of rheumatoid arthritis. A systematic review

Rituximab is a chimeric monoclonal antibody capable of depleting Bcells expressing CD20. Clinical trials carried out in patients diagnosedwith active, established RA confirm that a single cycle of rituximabgiven as two infusions a week apart, together with once weekly oralmethotrexate, produces enduring clinical responses comparable tothat observed with TNF blockade and may slow the rate of structuraldamage to joints. Rituximab, which has recently been approved for usein active rheumatoid arthritis refractory to TNF inhibitors, exhibits anacceptable safety record in rheumatoid arthritis trials, but its infusioncan be followed by reactions of variable frequency and severity which,in most instances, can be prevented by intravenous administration ofcorticosteroids and anti-histamines prior to the infusion. The long-termsafety record of rituximab as observed from the follow-up of patientstreated for non-Hodgkin’s lymphoma is favorable and reassuring.Current uncertainties regarding rituximab usage in rheumatoidarthritis are: (a) management of rituximab treatment failures, and (b)lack of reliable biomarkers to rationally indicate the best choice of thebiologic agent

NEW CONCEPTS IN PATHOGENESIS OF PRIMARY AND SECONDARY AMYLOID DISEASE

BOSTON UNIV HOSP,SCH MED,EVANS DEPT CLIN RES,ARTHRIT & CONNECT TISSUE DIS SECT,BOSTON,MA 02118Web of Scienc