OrthO-rheumatO | VOL 10 | Nr 4 | 2012
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kan worden. Het therapeutische effect van de competi
tieve anta gonisten van TNFareceptoren, meer bepaald
etanercept en lenercept, is dus hoogstwaarschijnlijk terug
te brengen tot de gecombineerde inhibitie van TNF en
lymfotoxine . Het RANKL/RANK-systeem blijkt zowel in
reumatoïde artritis als in inflammatoire myopathieën een
belangrijke pathofysiologische rol te spelen. Denosumab
(AMG-162), een monoklonaal anti-RANKL-antilichaam,
wordt momenteel getest voor de behandeling van reuma
toïde artritis, en is potentieel interessant voor inflamma
toire myopathieën. Het neutraliseren van BAFF is mogelijk
interessant voor de behandeling van autoimmune aandoe
ningen met een belangrijke humorale component. Hier
bij kan in eerste instantie gedacht worden aan DM, waar
B-cellen in groten getale voorkomen in het spierweefsel,
doch ook in PM/IBM, waar eveneens aanzienlijke aan
tallen gedifferentieerde plasmacellen worden aangetroffen.
Een anti-BAFF-antilichaam, LY2127399, wordt momen-
teel getest in klinische fase 2studies voor reumatoïde
artritis.
Het selectief uitschakelen van individuele TNFcytokines
biedt nieuwe perspectieven voor het uitwerken van the
rapieën voor inflammatoire myopathieën die efficiënter
zijn dan de huidige systemische immunosuppressiva. Die
laatsten gaan veelal gepaard met belangrijke bijwerkingen
en zijn bovendien lang niet werkzaam in alle patiënten
groepen. Verder onderzoek naar de specifieke rol van TNF-
cytokines bij het ontstaan en de progressie van de inflam
matoire myopathieën blijft noodzakelijk.
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