Emerging treatments
Tumor necrosis factor (TNF)-alpha blockers
Experience with TNF-alpha blockers in arthritis and arthralgias is very limited. They should be administered only with great caution, given that these agents have been known to induce systemic lupus erythematosus-like symptoms, though their efficacy in the treatment of rheumatoid arthritis is well established.
Immunosuppressants
There are emerging data on the use of newer immunosuppressive agents such as mycophenolate and the B-cell-depleting agent rituximab in myositis. One randomized trial evaluating the use of rituximab in patients with inflammatory myositis failed to reach its primary endpoint, but 83% of adults and children with refractory disease met the definition of improvement.[51] Additional studies are needed to define the role of rituximab in patients with myositis and muscle involvement in overlap syndromes. Among patients with antisynthetase syndrome and interstitial lung disease involvement, case reports and small case series exist of the utility of other immunosuppressive therapies, including mycophenolate, cyclosporine, cyclophosphamide, and tacrolimus, but there is no well-defined treatment approach.[52] Rituximab is an emerging agent that has shown benefit in the treatment of systemic sclerosis related interstitial lung disease, but its place remains to be clarified by larger randomized controlled trials.[53]
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