Specific Biologic Therapy with Tumor Necrosis Factor Inhibitors in Patients with Inflammatory Myopathy

Tumor necrosis factor (TNF) and TNF receptors are members of a family of molecules with important regulatory functions that include cellular activation and apoptosis. Neutralization of TNFa has proven to be effective in a variety of inflammatory disorders and autoimmune diseases such as rheumatoid arthritis and Crohn's disease. Treatment of inflammatory myopathies remains a challenge, especially in the case of refractory disease. Elevation of soluble tumor necrosis factor observed in patients with polymyositis/dermatomyositis has led to the suggestion that biologic therapies may be useful in these patients, although experience with anti-TNF agents is still limited. The aim of this mini-review is to summarize the biological bases for treatment of these patients with TNFα inhibitors, to look at the risks and benefits of this therapy -malignancy in patients with a recognized paraneoplastic association and infection versus therapeutic response in refractory myositisand to review the results of the currently reported cases.