Background Rheumatoid arthritis (RA) is a chronic, progressive, and inflammatory disease, resulting severe joint destruction. Recent reports on the treatment of anti-TNF-a agent have shown strong clinical efficacy in preventing destruction in joints of extremities. However, few reports are available to evaluate the efficacy on cervical lesions in RA.
Objectives We therefore performed the clinical and radiological study for RA patients with cervical lesions, who received the treatment with infliximab more than 3 years.
Methods Fifty one patients, who met the 1987 revised criteria of the American College of Rheumatology for the classification of RA, were studied prospectively. Infliximab 3mg/kg/week (Remicade; Centocor, Malvern, PA) was supplied continuously more than 3 years for 31 patients (IFX group). All patients in IFX group were treated with concomitant MTX (mean 7.1mg/week). Twenty patients, who were treated with MTX (mean 7.1mg/week) without infliximab were studied as control (Cont group). Disease Activity Score (DAS) 28-CRP was monitored throughout the period, and EULAR (European League Against Rheumatism) response rate was examined. Radiological parameters, including the atlanto-dental interval, Ranawat’s value and SS (subaxial subluxation: >3.5 mm) were determined using lateral-view plain radiographs. Statistical analysis was performed using Mann-Whitney Utest and χ2 test.
Results At baseline, two groups were comparable with respect to demographic characteristics, however, more patients were in high disease activity in IFX group than Cont group. DAS28-CRP values were improved statistically in IFX group (P=0.0001), but not in Cont group (P=0.90). The progression of atlantoaxial subluxation (AAS) was not observed in both groups. On the other hand, the progression of vertical subluxation (VS) was observed in Cont group (P<0.01) but not in IFX group (P=0.29). And the progression of SS was also observed in Cont group but not in IFX group (P<0.05).
Conclusions This study has shown that the treatment with infliximab can prevent the progression of cervical lesion in RA patients. Most of the patients in this study were advanced patients who had received DMARDs therapy or steroid therapy more than 3 years before this study. Recently, anti-TNF-a agent treatment is recommended for early stage of RA, since the repair of bone and articular destruction can be expected in such cases. The treatment with anti-TNF-a agent may prove to be highly effective strategy for preventing cervical lesion in patients at early stage of RA with high risk for disease progression.
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Disclosure of Interest None Declared
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