SONGÜL ÇİLDAĞ, TAŞKIN ŞENTÜRK, Berna GÜLTEKİN, GÖKHAN SARGIN

Anti-TNF tedavilerin tetiklediği otoimmünite

Amaç: Anti-TNF tedaviler günümüzde romatizmal hastalıkların tedavisinde etkin olarak kullanılmaktadır. Kullanımının artması ve uzun sürekli takiplerde tedavi ile ilişkili bazı yan etkiler de ortaya çıkmaktadır. Bu yan etkilerden birisi de otoimmünite gelişimidir. Bu çalışmanın amacı romatizmal hastalıkları nedeniyle anti-TNF tedavi alan hastalarda otoimmünite gelişim sıklığını belirlemektir. Gereç ve Yöntem: Çalışmaya romatoid artrit ve ankilozan spondilit hastalıkları nedeniyle anti-TNF tedavi almakta olan 67 hasta dahil edildi. Otuz iki hasta romatoid artrit, 35 hasta ankilozan spondilit idi. Otuz beş hasta infliximab, 16 hasta adalimumab, 16 hasta etanercept almaktaydı. Hastalık gruplarına ve anti-TNF tiplerine göre hastalar gruplara ayrıldı. ANA ve anti-dsDNA immünfloresan metodla, ACA ise ELISA yöntemi ile çalışıldı. Bulgular: ANA pozitifliğinde anti-TNF tedavi öncesi %10.4 iken, tedavi sonrasında %40.3 olarak anlamlı bir artış tespit edildi. Yalnızca bir hastada anti-dsDNA pozitifliği saptandı. ACA ise hastaların hiçbirinde pozitif değildi. Diğer iki anti-TNF'ye kıyasla ANA pozitifleşmesi infliximab kullanan hastalarda belirgindi. ANA pozitifliği saptanan hastaların hiçbirinde lupusa ait klinik mevcut değildi. ANA pozitifleşmesi ile anti-TNF tedavi ile birlikte kullanılan metotrexat ve kortikosteroid kullanımı arasında, romatizmal hastalık tipi arasında bir ilişki saptanmadı. Sonuç: Anti-TNF tedaviler, otoantikor gelişimini belirgin olarak arttırmaktadır. Ancak anti-TNF tedavilerin tetiklediği lupus gelişimi nadirdir

Anti-TNF therapy-induced autoimmunity

Aim: Anti-TNF therapy has recently emerged as an effective therapy for treating rheumatic diseases. With this increasing use and longer follow-up periods of treatment, various adverse effects are emerging. These adverse effects also include autoimmune processes. The aim of this study was to determine the autoimmune processes after anti-TNF therapy for rheumatic diseases. Materials and Methods: This study included 67 patients who were treated with anti-TNF drugs for rheumatoid arthritis and ankylosing spondylitis. Thirty-two patients with rheumatoid arthritis and thirty-five patients with ankylosing spondylitis were monitered. Thirty-five patients receiving infliximab, sixteen patients receiving adalimumab, sixteen patients receiving etanercept. According to the rheumatic diseases groups and anti-TNF therapies groups, the patients were divided into subgroups. The ANA and anti-dsDNA antibody levels were identified by the immunefluorescence method and ACA antibody levels were identified by the ELISA methods. Results: In this study, the percentages of ANA positivity in sixty-seven patients range from 10.4% to 40.3%. Only one patient had serum level of anti-dsDNA. No patient had serum level of ACA. ANA induction was more important under infliximab than with the two other anti-TNF blockers. No patient developed clinical symptoms of lupus who had been seroconversion of antibody. ANA was not influenced by the underlying rheumatism or anti-TNF combined therapies with methotrexate and corticosteroids. Conclusion: Anti-TNF induced autoantibodies are common following therapy with all of the currently available antiTNF therapies. However the incidence of anti-TNF inducel lupus is rare

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