кто-нибудь знает что о TNFa (фактор некроза опухолей) и его роли в развитии ревматоидного и псориазного полиартрита?

[Борис Скрябин]

Киста вилочковой железы

TNF-? inhibitors should be used in consultation with a rheumatologist. Rarely, serious infections have occurred in patients treated with these agents. Therefore, they are not indicated for patients with indolent chronic infections, such as osteomyelitis or tuberculosis, or for anyone with significant and active common infections. Patients with a serious infection such as pneumonia should discontinue treatment with these agents until they receive appropriate therapy for the infection and demonstrate significant improvement.Toxicity associated with the TNF-? inhibitors includes reactivation tuberculosis with fulminant extrapulmonary involvement. Purified protein derivative testing is indicated before beginning treatment with these agents, and positive results on this test warrant treatment for latent tuberculosis (see Special Issues in Patients Taking Pharmacologic Immunosuppressants).Rare cases of multiple sclerosis or demyelinating conditions such as optic neuritis have been reported but usually remit upon discontinuation of therapy. TNF-? inhibitors also may cause or exacerbate heart failure.

[Ольга Лобанова Фитасова Гутман]

TNF-? inhibitors have been associated with a drug-induced SLE syndrome. Approximately 10% of patients treated with TNF-? inhibitors develop antinuclear antibodies and anti–double-stranded DNA antibodies. There is also evidence that TNF-? inhibitors may increase the risk of cancer, particularly lymphoma, some solid cancers, and skin cancer. However, patients who are prescribed TNF-? inhibitors often have an increased risk of cancer because of their underlying disease; therefore, the causality is difficult to prove. Furthermore, associated treatments such as cyclophosphamide, methotrexate, and azathioprine also increase the risk of cancer.Studies attempting to demonstrate a relationship between TNF-? inhibitors and lymphoma and solid-organ malignancies have yielded mixed results. In a study that used the National Data Bank for Rheumatic Diseases, the odds ratio for developing melanoma was approximately 2.0 but did not reach statistical significance. Nevertheless, standard practice based on expert opinion is to discontinue TNF-? inhibitor therapy in patients who develop cancer, including melanomas.

[Ольга Лобанова Фитасова Гутман]

источник http://mksap15.acponline.org/syllabus/chapters/rm_s2_4_1

[Ольга Лобанова Фитасова Гутман]

еще http://www.ijccm.org/article.asp?issn=0972-5229;year=2007;volume=11;issue=3;spage=139;epage=148;aulast=Sharma

[Ольга Лобанова Фитасова Гутман]

вторая ссылка- индийская публикация