The effect of TNFalpha blockade on the antinuclear antibody profile in patients with chronic arthritis: biological and clinical implications

Since the first proof of efficacy of TNFalpha blockade, both the number of patients treated worldwide and the number of indications for treatment with TNFalpha blockers have grown steadily. Surprisingly, the profound immunomodulation induced by anti-TNFalpha therapy is associated with a relatively l...

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Bibliographic Details
Published in:Lupus 2005-01, Vol.14 (12), p.931-937
Main Authors: De Rycke, L, Baeten, D, Kruithof, E, Van den Bosch, F, Veys, E M, De Keyser, F
Format: Article
Language:English
Subjects:
Antibodies
Antibodies, Antinuclear - analysis
Antibodies, Monoclonal - pharmacology
Antigens
Arthritis - drug therapy
Arthritis - immunology
Arthritis, Rheumatoid - drug therapy
Arthritis, Rheumatoid - immunology
Autoimmune Diseases - drug therapy
Autoimmune Diseases - immunology
DNA - immunology
Etanercept
Humans
Immunoglobulin G - pharmacology
Immunoglobulin M - immunology
Immunologic Factors
Infliximab
Lupus
Lupus Vulgaris - immunology
Pathophysiology
Receptors, Tumor Necrosis Factor
Rheumatoid arthritis
Rheumatology
Serology
Tumor Necrosis Factor-alpha - antagonists & inhibitors
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Summary:Since the first proof of efficacy of TNFalpha blockade, both the number of patients treated worldwide and the number of indications for treatment with TNFalpha blockers have grown steadily. Surprisingly, the profound immunomodulation induced by anti-TNFalpha therapy is associated with a relatively low incidence of immune-related complications such as lupus-like syndromes and demyelinating disease. This contrasts sharply with the prominent induction of autoantibodies such as antinuclear antibodies (ANA) and anti-dsDNA antibodies during TNFalpha blockade. Although this phenomenon has been recognized for several years, the clinical and biological implications are not yet fully understood. In this review, recent studies analysing the effect of TNFalpha blockade (infliximab and etanercept) on the ANA profile in autoimmune arthritis will be discussed. Taken together, these reports indicate that the prominent ANA and anti-dsDNA autoantibody response is 1) not a pure class effect of TNFalpha blockers, 2) independent of the disease background, 3) largely restricted to the induction of short-term IgM anti-dsDNA antibodies, and 4) not associated with other serological or clinically relevant signs of lupus. Nevertheless, a careful follow-up of patients treated with TNFalpha blockers remains mandatory, including monitoring for lupus-like characteristics.
ISSN:0961-2033
1477-0962
DOI:10.1191/0961203305lu2240rr