Silvia Bosello, MD; Maria De Santis, MD; Barbara Tolusso, BS; Angelo Zoli, MD; Gianfranco Ferraccioli, MD
Potential Financial Conflicts of Interest: None disclosed.
Bosello S, De Santis M, Tolusso B, Zoli A, Ferraccioli G. Tumor Necrosis Factor-α Inhibitor Therapy in Erosive Polyarthritis Secondary to Systemic Sclerosis. Ann Intern Med. 2005;143:918-920. doi: 10.7326/0003-4819-143-12-200512200-00019
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Published: Ann Intern Med. 2005;143(12):918-920.
TO THE EDITOR:
Background: Inflammatory arthritis can occur in patients with systemic sclerosis. In some cases, the condition is erosive and the patient is rheumatoid factor–seronegative, whereas some patients have rheumatoid arthritis that overlaps with diffuse (1) or limited (2) systemic sclerosis. Symptoms may not respond to corticosteroid or methotrexate therapy.
Objective: To evaluate the effect of tumor necrosis factor (TNF)-α inhibitors in a subset of patients with erosive polyarthritis secondary to systemic sclerosis.
Methods and Findings: The study enrolled 4 consecutive patients with systemic sclerosis that fulfilled the classification criteria of the American College of Rheumatology (ACR); all patients gave informed consent. All patients had erosive polyarthritis that did not respond to corticosteroid or methotrexate therapy. In each case, the patient had received 3 annual 5-day courses of intravenous iloprost, 150 mg of penicillamine daily, and calcium-channel blockers since diagnosis of systemic sclerosis. A clinical evaluation and joint count were performed at baseline and were repeated every 2 months; the Stanford Health Assessment Questionnaire was also administered each time the patient was re-evaluated. At each visit, 2 observers used the modified Rodnan skin score to categorize skin thickness. After the sixth month, patients were considered to be responding to treatment if their Disease Activity Score decreased below 3.7 and the global decrement was at least 1.2.
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