Background Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease with a poor prognosis in which synovitis induces progressive destruction of bones and joints, which leads to marked impairment of the activities of daily living.More timely and effective therapy for rheumatoid arthritis has contributed to increasing rates of clinical remission. However, progression of structural damage may still occur in patients who have satisfied remission criteria (1,2).Most RA patients who satisfied the remission criteria with normal findings on clinical and laboratory studies had imaging-detected synovitis may explain the observed discrepancy between disease activity and outcome in RA (3).
Objectives To evaluate theeffects of double filtration plasmapheresis (DFPP) in combination with Leflunomide and methotrexate on magnetic resonance imaging (MRI)-detected inflammatory changes (synovitis and bone marrow edema) in early rheumatoid arthritis (RA) patients with high disease activity.
Methods Sixty RA patients with high active disease of 6 months to3 years’ duration were randomized to DFPP group and no-DFPP group. All patients received leflunomide10mg, two times daily, plus methotrexate15mg orally once weekly. DFPP was performed in the DFPP group once 1-2 weeks for 3 sessions. The primary end point was the improvement in MRI-detected synovitis from baseline over 6 months. Secondary end point variables included Clinical remission in DAS28 and ACR20, ACR50, ACR70 and ACR90 responses for 6 consecutive months.
Results The study achieved a significant reduction in synovitis compared with baseline, witha reduction of 7 in the median synovitis score from baseline to month 6in the DFPP group compared with 0 in the median synovitis score from baseline to month 6for the no-DFPP group (P<0.001). Synovitis scores in 48.39% (15/31)of the Patients in the DFPP group were 0 at month 6.Bone edema scores in 32.26% (10/31) of the Patients in the DFPP group were 0 at month 6. ACR20, ACR50, ACR70 and ACR90 responses for 6 consecutive months had been achieved in 100% of patients in the DFPP group, compared with 37.93%, 20.69%, 10.34%, 0% respectively, of patients in the no-DFPP group (P<0.001). DAS28 remissionfor 6 consecutive months was achieved in 100% of patients in the DFPP group, compared with 6.90%of patients in the no-DFPP group (P<0.001).
Conclusions The combination of DFPP and DMARDs is superior to DMARDs alone for reducing MRI-detected signs of synovitis and bone edema in patients with early high active rheumatoid arthritis. The DFPP therapy enables a rapid and more complete suppression of inflammation in patients withearly high active rheumatoid arthritis. Nearly half of the patients (48.39%) who had received DFPP therapy achieved both clinical remission and imaging remission,a true remission.
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Disclosure of Interest None Declared
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