title: Rheumatoid arthritis: refractory to infliximab, a tumor necrosis factor inhibitor.
abstract: Rheumatoid arthritis is one of the commonest autoimmune diseases. It is a chronic, progressive, systemic inflammatory disorder affecting the synovial joints and typically producing symmetrical arthritis. If left untreated, it leads to joint destruction and thus deformity and disability.In the recent years, advances in molecular biology have led to a variety of new treatment approaches to rheumatoid arthritis and other systemic inflammatory diseases associated with autoimmunity. Anti tumor necrosis factor (TNF) agents are emerging in the frontline management of rheumatoid arthritis (RA) in the current era of biological treatment. We presented a 46-year-old Chinese female with a history of seropositive RA for the past 22 years refractory and intolerant to multiple medications including sulphasalazine (SSZ), leflunomide, hydroxychloroquine (HCQ) and methotrexate (MTX), thus infliximab, a tumor necrosis factor (TNF) inhibitor was initiated. However, despite receiving 6 cycles of infliximab therapy, she still complained of persistent disabled multiple joint pain and swelling. This report will discuss about rheumatoid arthritis, which is refractory to infliximab (a TNF inhibitor) and its alternative.
  
  
  BACKGROUND
  Rheumatoid arthritis; Biologics treatment; Tumor-necrosis factor inhibitor; Infliximab.
authors.affiliation: Universiti Sains Islam Malaysia, Nilai, Malaysia.
authors.forename: Hana Maizuliana Bt
authors.initials: HM
authors.lastname: Solehan
authors.forename: Mohd Shahrir Mohamed
authors.initials: MS
authors.lastname: Said
authors.forename: Sazliyana
authors.initials: S
authors.lastname: Shaharir
authors.forename: Sakthiswary
authors.initials: S
authors.lastname: Rajalingham