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Ann Rheum Dis. Oct 2004; 63(10): 1344–1346.
Published online Mar 19, 2004. doi:  10.1136/ard.2003.014878
PMCID: PMC1754777

True infliximab resistance in rheumatoid arthritis: a role for lymphotoxin α?

Abstract

Case report: A patient with RA resistant to repeated high dose infliximab infusions and intra-articular infliximab into an inflamed knee is described. No beneficial clinical effect was observed. Pre-injection arthroscopic biopsy of the study knee demonstrated TNFα staining but also confirmed the presence of lymphotoxin α (LTα or TNFß) on immunohistochemistry. Subsequent treatment with etanercept (which blocks LTα as well as TNFα) resulted in clinical remission of disease.

Conclusion: This case suggests that resistance to TNF blockade may occur when TNFα is not the dominant inflammatory cytokine and suggests that LTα may have a pathogenic role in RA.

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Figure 1
 Panels (A) and (D) are the negative controls for the study patient and positive control respectively. Panels (B) and (E) demonstrate TNFα expression detected with anti-TNFα monoclonal mouse IgG1 clone 28401 in the study patient ...

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