Refractory polymyositis responding to infliximab

I. Uthman and J. El-Sayad

Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon

Correspondence to: I. W. Uthman, American University of Beirut Medical Center, PO Box: 113-6044, Hamra, Beirut 1103 2090, Lebanon. E-mail: iuthman{at}aub.edu.lb

SIR, We read with great interest the article by Labioche et al. [1] reporting the case of a lady with refractory polymyositis (PM) that dramatically responded to the addition of the anti-tumour necrosis factor-{alpha} (anti-TNF-{alpha}) agent infliximab. We would like to report a similar case seen at the American University of Beirut Medical Center, of a 33-year-old female with a 5 yr history of PM, proven by muscle biopsy and electromyography. She was resistant to steroids and multiple immunosuppressants, including azathioprine and methotrexate, over the course of her illness. Her disease was quite disabling, she lost her job and she was unable to take care of her family. On 17 October 2002 her serum creatine kinase (CK) was 1286 IU/l and she was given her first infliximab infusion (300 mg). Thereafter she was given four additional doses of infliximab, the last one being on 9 June 2003. Table 1 shows dates of the infliximab infusions and the CK levels. The drop in the CK levels was associated with a marked improvement in her muscle powers. In addition to infliximab she was given methotrexate 10 mg weekly. On her last evaluation on 25 February 2004, she was asymptomatic, still taking methotrexate 10 mg weekly, and her CK level was 41 IU/l. Our case lends further support to the fact that anti-TNF-{alpha} therapy may result in a dramatic and sustained response in patients with refractory inflammatory myopathies.


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TABLE 1. Patient's response to infliximab, as assessed by serum CK measurements

 
The authors have declared no conflicts of interest.

References

  1. Labioche I, Liozon E, Weschler B, Loustaud-Ratti V, Soria P, Vidal E. Refractory polymyositis responding to infliximab: extended follow-up. Rheumatology 2004;43:531–2.[Free Full Text]
Accepted 13 May 2004