Tumor necrosis factor inhibitors for rheumatoid arthritis

Rheumatoid arthritis developed in a 25-year-old woman, who was found to have a positive rheumatoid factor (150 IU per milliliter); she had no periarticular radiologic erosions or extraarticular disease. Oral methotrexate was started and incrementally increased to 20 mg weekly. Subsequently, sulfasalazine (Salazotyrin, Pharmacia; Azulfidine, Pfizer) was added and gradually increased to 2 g daily. Despite six months of combination therapy, she had 10 swollen and tender joints and an elevated erythrocyte sedimentation rate (54 mm per hour). Twelve months after onset, we were asked to evaluate her for possible tumor necrosis factor (TNF) inhibitor therapy. Copyright © 2006 Massachusetts Medical Society.