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Department of
Rheumatology, University Medical Centre St Radboud, Nijmegen, the
Netherlands
Correspondence to: Dr van den Berg, Rheumatology Research Laboratory, University Medical Centre St Radboud, 6500 HB Nijmegen, the Netherlands (w.vandenberg{at}reuma.azn.nl)
Tumour necrosis factor (TNF) and interleukin 1 (IL1) are
considered as master cytokines in chronic, destructive arthritis. Therapeutic approaches in rheumatic arthritis (RA) patients so far
mainly focused on TNF. Although TNF is a major inflammatory mediator in
RA and a potent inducer of IL1, anti-TNF treatment is not effective in
all patients, nor does it fully control the arthritic process in
affected joints of good responders. Analysis of cytokine patterns in
early synovial biopsy specimens of RA patients reveals prominent TNF
staining in 50% of the patients, whereas IL1b staining was evident in
100%. This argues that TNF independent IL1 production occurs in some
of the patients. Studies in a range of experimental arthritis models in
mice make it clear that TNF is involved in early joint swelling.
However, TNF alone is not arthritogenic nor destructive and exerts its
arthritogenic potential through IL1 induction. Intriguingly, TNF
independent IL1 production is found in many models. Its relevance is
further underlined by the greater efficacy of anti-IL1 treatment as
compared with anti-TNF treatment and the total lack of chronic, erosive arthritis in IL1b deficient mice. IL1b is not necessarily involved in
early joint swelling, but is a crucial mediator in chronic arthritis
and cartilage erosion in all models studied so far. This makes ILb an
attractive target in chronic, destructive arthritis.
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