CASE 23
Jurgat is a 45-year-old woman of Indian descent with severe erosive deforming rheumatoid arthritis (RA) that began at the age of 22. She has had ongoing joint problems and more recently has experienced early signs of renal failure and some chest discomfort. She has tried without benefit all conventional anti-inflammatory therapies, including NSAIDs and chronic prednisone therapy (which left her with severe osteoporosis), as well as methotrexate and even cyclosporine. She became a good candidate for more experimental approaches but she has already experienced failure in a trial using antibody to human intercellular adhesion molecule (ICAM). What was the rationale for use of this agent? What is the potential pathophysiology behind her disease manifestations?