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Giant cell arteritis and polymyalgia rheumatica are related inflammatory diseases. Corticosteroids are the only effective treatments for both. Searching for something less toxic, researchers were drawn to infliximab, a monoclonal antibody against tumour necrosis factor. But it failed to help patients with either disease in two separate trials. The trials compared groups of patients given steroids alone or steroids plus infliximab. Patients in both trials had high rates of recurrence or relapse, whatever treatment they received.
Although the trials were small (n=51 and n=44), and the confidence intervals of both sets of results relatively wide, infliximab now looks an unlikely treatment for giant cell arteritis or polymyalgia rheumatica, says an editorial (pp 674-6). The evidence linking tumour necrosis factor to either disease is weak, and the researchers may have picked the wrong target. Others should concentrate on refining existing steroid treatment and continue to explore the role of other cytokines such as interleukin 6.