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Dr. Richette and Dr. Bardin reply To the Editor: We read with interest the letter from Dr. Garcia-Porrua and colleagues describing another case of successful treatment of rheumatoid vasculitis-associated mononeuritis with infliximab. The authors use anti-TNF-a blockers as a first-line therapy instead of intravenous cyclophosphamide to treat patients with rheumatoid vasculitis. Some clinicians have previously reported the efficacy of TNF-a-blocking therapy during rheumatoid vasculitis1,2. By contrast, we and others have observed cutaneous3, neurological4,5, or antineutrophil cytoplasmic autoantibody-related6 vasculitis induced by anti-TNF-a agents. In this context, the use of TNF-a blockers during rheumatoid vasculitis may be hazardous. Although the scientific interest of a single case observation is of limited value, it may alert us to potential side effects. We need a definitive controlled trial to ascertain the efficacy of anti-TNF-a agents to treat rheumatoid vasculitis. PASCAL RICHETTE, MD, PhD; THOMAS BARDIN, MD, Fédération de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, 2 rue Ambroise Paré, Paris, France. E-mail: pascal.richette@lrb.ap-hop-paris.fr 1. Armstrong DJ, McCarron MT, Wright GD. Successful treatment of rheumatoid vasculitis-associated foot-drop with infliximab [letter]. J Rheumatol 2005;32:759. Reply. J Rheumatol 2005;32:759-60. 2. Unger L, Kayser M, Nusslein HG. Successful treatment of severe rheumatoid vasculitis by infliximab. Ann Rheum Dis 2003;62:587-8. 3. Flendrie M, Vissers WH, Creemers MC, de Jong EM, van de Kerkhof PC, van Riel PL. Dermatological conditions during TNF-alpha-blocking therapy in patients with rheumatoid arthritis: a prospective study. Arthritis Res Ther 2005;7:R666-76. 4. Jarrett SJ, Cunnane G, Conaghan PG, et al. Anti-tumor necrosis factor-alpha therapy-induced vasculitis: case series. J Rheumatol 2003;30:2287-91. 5. Richette P, Dieude P, Damiano J, Liote F, Orcel P, Bardin T. Sensory neuropathy revealing necrotizing vasculitis during infliximab therapy for rheumatoid arthritis. J Rheumatol 2004;31:2079-81. 6. Doulton TW, Tucker B, Reardon J, Velasco N. Antineutrophil cytoplasmic antibody-associated necrotizing crescentic glomerulonephritis in a patient receiving treatment with etanercept for severe rheumatoid arthritis. Clin Nephrol 2004;62:234-8. |