title: Infliximab as a treatment option for patients with rheumatoid arthritis and primary biliary cirrhosis.
abstract: Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease which commonly requires treatment with biologic agents targeting various inflammatory pathways. Tumor necrosis factor alpha is a proinflammatory cytokine which plays a pivotal role not only in the pathogenesis of RA but also in other autoimmune diseases such as primary biliary cirrhosis. The co-existence of more than one autoimmune disorder in the same individual is very challenging in the daily practice as therapy strategies applicable to one disease setting may cause clinical and/or biochemical relapse of the other clinical entity. As a result, treatment options able to control different diseases are highly desirable among rheumatologists and other specialties. In that respect, we present a case of a 61-year-old female patient with RA and concomitant primary biliary cirrhosis with poor clinical response to conventional disease-modifying drugs for RA. The introduction of tumor necrosis factor alpha antagonist infliximab led to significant clinical improvement of RA and to stabilization of liver function. In this case review study, we discuss aspects of pathophysiology of primary biliary cirrhosis associated with tumor necrosis alpha and we review the available data of similar published cases.
authors.affiliation: 4th Department of Internal Medicine, Hippokratio Hospital, Konstantinoupoleos 49, 54642, Thessaloniki, Greece.
authors.forename: Despoina
authors.initials: D
authors.lastname: Dimopoulou
authors.affiliation: 4th Department of Internal Medicine, Hippokratio Hospital, Konstantinoupoleos 49, 54642, Thessaloniki, Greece. dimitroul@hotmail.com.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Dimitroulas
authors.affiliation: 4th Department of Internal Medicine, Hippokratio Hospital, Konstantinoupoleos 49, 54642, Thessaloniki, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Akriviadis
authors.affiliation: 4th Department of Internal Medicine, Hippokratio Hospital, Konstantinoupoleos 49, 54642, Thessaloniki, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Garyfallos
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D008105:Liver Cirrhosis, Biliary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Infliximab; Primary biliary cirrhosis; Rheumatoid arthritis; TNFa inhibitors