Successful treatment of inflammatory knee osteoarthritis with tumour necrosis factor blockade

Increasing evidence indicates that tumour necrosis factor (TNF) has an important role not only in inflammatory arthritis but also in degenerative joint disease. 1- 3 TNF controls the homoeostasis of matrix synthesis and matrix degeneration in articular cartilage in concert with other cytokines, such as interleukin 1 (IL1), transforming growth factor β, or insulin-like growth factor 1. In osteoarthritis (OA), increased TNF production by activated synoviocytes and articular chondrocytes together with increased p55 TNF receptor expression on chondrocytes imply the contribution of TNF mediated matrix degradation to disease pathogenesis. 1, 4, 5 As inhibition of TNF has been shown to suppress nitric oxide production in human cartilage, 6 the hypothesis can be formulated that anti-TNF therapy might be a promising strategy for the treatment of OA. 7- 9 A common clinical feature of OA is bone marrow oedema, which can be detected and quantified by magnetic resonance imaging (MRI).