Anti Tumor Necrosis Factor Alpha and Renal Disease in Rheumatoid Arthritis

Résumé

Tumor necrosis factor alpha (TNF-α) is a potent and critical proinflammatory cytokine produced by the immune cells especially macrophages and T lymphocytes, however other cell of the immune system such as white blood cells, renal tubular cells, vascular endothelial cells also produce it in small quantities. TNF-α has both physiological and pathological roles, an important family of both the soluble and cell bound subunit of cytokines and its primary role is promotion of inflammation. It is also involved in lymphoid development and has cytotoxic and apoptotic effects. This master proinflammatory cytokine has been implicated in diseases such as rheumatoid arthritis (RA) especially with renal involvement, and others include ankylosing spondylitis, Crohn’s disease. The advent of anti TNF-α has also promising results in managing these conditions. Epidemiologically we know that renal insufficiency is a common occurrence in patients with rheumatic arthritis and this limits the use of non-steroidal anti-inflammatory drugs (NSAIDs) and disease modifying anti-rheumatic drugs (DMARDs). The buildup of TNF-α levels in chronic kidney disease may justify the use of these agent.

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