Anticytokine Therapy — A New Era in the Treatment of Rheumatoid Arthritis?

With the clinical availability of two different approaches to decrease the activity of tumor necrosis factor (TNF), a new era in the treatment of rheumatoid arthritis has begun. In this issue of the Journal, Weinblatt and colleagues report significant improvement when etanercept was added to therapy with methotrexate for patients with rheumatoid arthritis.1 TNF plays a pivotal role in the host's immune system.2 It is an important mediator of local inflammation that appears to be vital in keeping infections localized. The release of TNF-α results in local activation of vascular endothelium, release of nitric oxide with vasodilatation, and increased vascular . . .