Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Response to ‘Effect of etanercept in polymyalgia rheumatica: a randomized controlled trial’. | Watson and Gaston Arthritis Research Therapy 2011 13 403 http content 13 2 403 LETTER L_ Response to Effect of etanercept in polymyalgia rheumatica a randomized controlled trial Pippa Watson and Hill Gaston See related research by Kreiner and Galbo http content 12 5 R176 We read with interest the article recently published in Arthritis Research Therapy by Kreiner and Galbo 1 that reported a very modest benefit of etanercept monotherapy in polymyalgia rheumatica PMR . There is some evidence that TNFa can be found in the lesions of giant cell arteritis GCA 2 . However two previous randomised controlled trials 3 4 showed no benefit of TNFa inhibition in the treatment of PMR GCA. We report for the first time the development of PMR and GCA in two patients undergoing treatment with anti-TNFa drugs. This suggests that the underlying immunopathology of GCA PMR is not driven by TNFa and casts further doubt on the likely usefulness of TNFa blockade in these conditions. The first patient was a woman aged 72 years with ankylosing spondylitis. Adalimumab was commenced in July 2006 with good effect. On review in August 2009 she reported increasing pain and stiffness in her shoulders and pelvic girdle. Her usual ankylosing spondylitis-related lower back pain remained well controlled. Her new symptoms did not respond to diclofenac however within 48 hours of starting prednisolone 15 mg once daily there was a marked and sustained improvement. This was maintained until in subsequent months prednisolone was reduced to 5 mg when recurrence of symptoms again responded promptly to an increased dose. The rapid response to glucocorticoids and the sensitivity to changes in dose strongly support the clinical diagnosis of PMR. The second patient a woman aged 75 years was treated with adalimumab 40 mg fortnightly and daily leflunomide 10 mg and prednisolone mg for seropositive erosive rheumatoid arthritis. Initially she responded well to
