FROM INTERNAL MEDICINE: OPEN ACCESS

The anti–tumor necrosis factor alpha agent infliximab is a beneficial option in the treatment of concurrent rheumatoid arthritis (RA) and primary biliary cholangitis (PBC), according to A.K. Ben, MD, and associates.

In a case report, a 56-year-old woman presented with 5 years of evolving symmetrical polyarthritis involving her large and small joints, and was diagnosed with RA. Methotrexate was initially used as treatment, but after 6 months of continued high disease activity, infliximab was added to treatment. The patient showed good clinical response to the combination treatment.

The combination treatment was stopped after the patient showed abnormal liver function. Antimitochondrial antibody testing was positive, and after a liver biopsy to confirm, the patient was diagnosed with PBC. Ursodeoxycholic acid was prescribed and liver function was normalized.

The patient was restarted on methotrexate and 3 mg/kg infliximab when the RA flared after 6 months and was persistent until the dosage of infliximab was increased to 5 mg/kg. This was effective in the patient, who has experienced disease decline for 5 years.

“Additional studies may be considered to better explore the therapeutic role (dosage and molecule disparities) of TNF [tumor necrosis factor] blockers on clinical and morphological course of PBC associated with RA,” the investigators concluded.

Find the full case report in Internal Medicine: Open Access ( doi: 10.4172/2165-8048.1000250 ).

lfranki@frontlinemedcom.com

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