ADALIMUMAB IS A RECOMBINANT HUMAN MONOCLONAL TUMOUR NECROSIS FACTOR (TNF) ANTIBODY THAT BINDS SPECIFICALLY TO TNF-? AND BLOCKS ITS INTERACTION WITH ENDOGENOUS CELL-SURFACE TNF RECEPTORS. IT ALSO MODULATES BIOLOGICAL RESPONSES THAT ARE INDUCED OR REGULATED BY TNF. ELEVATED LEVELS OF TNF HAVE BEEN FOUND IN THE SYNOVIAL FLUID OF PATIENTS WITH RHEUMATOID ARTHRITIS, AND ANKYLOSING SPONDYLITIS, AND PSORIATIC ARTHRITIS. ADALIMUMAB IS USED IN THE TREATMENT OF MODERATE TO SEVERE, ACTIVE RHEUMATOID ARTHRITIS, SEVERE, ACTIVE ANKYLOSING SPONDYLITIS, AND ACTIVE AND PROGRESSIVE PSORIATIC ARTHRITIS. IN THE UK, ITS USE IS USUALLY LIMITED TO PATIENTS WHO HAVE HAD AN INADEQUATE RESPONSE TO STANDARD DISEASE-MODIFYING ANTIRHEUMATIC DRUGS ALTHOUGH, IN SEVERE PROGRESSIVE RHEUMATOID ARTHRITIS, IT MAY BE USED IN PATIENTS NOT PREVIOUSLY TREATED WITH METHOTREXATE. IN THE USA, IT MAY BE USED FOR TREATING EARLY RHEUMATOID ARTHRITIS OR PSORIATIC ARTHRITIS, TO REDUCE THE SIGNS AND SYMPTOMS AND DELAY STRUCTURAL DAMAGE.