RESUMO
Neuroinflammatory (demyelinating) disease is a rare but feared complication of treatment with anti-tumour necrosis factor (TNF)alpha in patients with polyarthritis. In this study, blood and cerebrospinal fluid markers of inflammation were analysed in 10 people with polyarthritis before and during treatment with infliximab. An increased systemic expression of interferon (IFN)gamma was detected. Systemic administration of IFNgamma is known to exacerbate multiple sclerosis. However, the present study failed to detect signs of inflammation in the cerebrospinal fluid samples-that is, pleocytosis, oligoclonal immunoglobulin G bands, increased expression of IFNgamma, TNFalpha or interleukin 10, or increased levels of nitric oxide oxidation products. Our initial hypothesis, that the few cases of clinical neuroinflammatory disorders observed during treatment of polyarthritis with anti-TNFalpha represent the extreme end of a commonly occurring minor intrathecal immune activation, which in most cases does not give any overt neurological dysfunction, was not supported. Induction of systemic IFNgamma production may still be relevant in neuroinflammation associated with treatment with anti-TNFalpha.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite/líquido cefalorraquidiano , Mediadores da Inflamação/líquido cefalorraquidiano , Adulto , Idoso , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite/tratamento farmacológico , Artrite/imunologia , Proteína C-Reativa/metabolismo , Feminino , Humanos , Imunoglobulina G/líquido cefalorraquidiano , Mediadores da Inflamação/sangue , Infliximab , Interferon gama/biossíntese , Interferon gama/genética , Interleucina-10/biossíntese , Pessoa de Meia-Idade , Óxido Nítrico/sangue , Óxido Nítrico/líquido cefalorraquidiano , Oxirredução , RNA Mensageiro/genética , Índice de Gravidade de Doença , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/biossíntese , Regulação para Cima/efeitos dos fármacosRESUMO
Gonarthrosis in 11 human T cell leukemia virus-1 (HTLV-I) carriers were studied for sera, synovial fluids (SF) and cerebrospinal fluids (CSF). Atypical lymphocytes similar to adult T cell leukemia cells were noticed in the SF of all the HTLV-I carriers and ranged from 19 to 1%, while those of peripheral white blood cells ranged from 3 to 0%. Anti-HTLV-I antibodies in the SF were equal to or lower than those in the sera. The CSF from 7 of them demonstrated positive titers of anti-HTLV-I antibodies, while no evidence of neurological disorders manifested. The histopathological findings of synovial membranes on hematoxylin and eosin staining method showed no statistical difference between those of gonarthrosis of HTLV-I carriers and noncarriers.
