OrthO-rheumatO | VOL 11 | Nr 6 | 2013
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cytokine TNF- is overvloedig aanwezig in het serum
en synovium van RA-patiënten. TNF- veroorzaakt de
belangrijkste kenmerken voor RA nl. ontsteking, osteo-
clastogenese en de daaropvolgende destructie van weef-
sel en boterosie in de perifere gewrichten. Vanwege de
centrale rol in de pathofysiologie van RA, werden hier
de productie en werking van TNF- besproken en de
huidige behandelingsmogelijkheden toegelicht. TNF-
wordt door verschillende cellen in de ontstoken gewrich-
ten geproduceerd. Dit cytokine heeft verschillende directe
en indirecte effecten door de binding aan TNFR en de
inductie van inflammatoire mediatoren zoals integrines,
adhesiemoleculen en chemokinen. Het blokkeren van de
werking van TNF- d.m.v. anti-TNF--drugs (adalimu-
mab, certolizumab, etanercept, golimumab en infliximab)
is momenteel een veelgebruikte methode om RA succes-
vol te behandelen. Een aanzienlijk deel van de RA-patiën-
ten reageert echter niet op deze anti-TNF--therapie. De
remming van andere cytokinen zoals IL-1 en RANKL, of
van chemokinereceptoren zoals CCR1, vormt daarom een
alternatieve benadering om deze ziekte in de toekomst
effectief te behandelen.
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