SUBOPTIMAL CLINICAL-RESPONSE TO ANTITUMOR NECROSIS FACTOR-ALPHA (TNF-ALPHA) ANTIBODY THERAPY IN A PATIENT WITH SEVERE RHEUMATOID-ARTHRITIS AND LYMPHADENOPATHY

This concerns a patient with severe rheumatoid arthritis (RA) and lymp hadenopathy (LA) who showed suboptimal clinical response to anti-tumor necrosis factor alpha (TNF alpha) antibody (Ab), cA2 therapy. The ass essment of TNF alpha and IL-6 mRNA expression in the swollen lymphnode (LN) of the patient by reverse transcription, polymerase chain reacti on (RT-PCR) before cA2 treatment, showed only enhanced IL-6 production , but not TNF alpha Moreover, cA2 failed to inhibit in-vitro spontaneo us IL-6 production in the LN block culture from the patient. Taken tog ether, these results indicate that IL-6 production in the swollen LNs of the patient might not depend on TNF alpha This might partly cause s uboptimal clinical response to anti-TNF alpha Ab therapy in the patien t.