Background In rheumatoid arthritis (RA), in order to prevent the progression of joint destruction, it is important to prevent synovitis, primarily in swollen joints. We have already reported that Tocilizumab (TCZ) treatment for 3 months1) and 6 months2) resulted in rapid improvement in disease activity and synovitis.
Objectives To evaluate synovitis in patients remaining in clinical remission on TCZ treatment.
Methods We investigated the 1-year therapeutic efficacy of patients started on TCZ at the same time. Patients received TCZ 8 mg/kg every 4 weeks. Disease activity was assessed using the DAS28-ESR. Maintenance of clinical remission was defined as a mean DAS28 score lower than 2.6 from 24 weeks to 52 weeks after TCZ treatment initiation. Swollen joint count (SJC) was assessed by 28 joints. Synovitis was assessed semi-quantitatively (Grades 0-3) using ultrasonography for hand, wrist, elbow, and knee joints for which the patient complained of symptoms or which exhibited signs of synovitis.3) The chi-squared test and the Wilcoxon test were used for the statistical analysis.
Results We studied 214 assessment joints in 47 patients. The mean age (years) was 53.3±15.3, and the mean disease duration (years) was 10.0±7.1. The mean DAS28-EAR at treatment initiation was 5.19±1.06, the mean SJC was 7.7±4.5, and 66% of the patients had received biological agents in the past. The mean DAS28-ESR at 52 weeks was significantly improved to 2.57±0.85 (p<0.001). There were 17 patients (36.2%) who remained in clinical remission from 24 weeks to 52 weeks after TCZ treatment initiation. Grade 0 in patients remaining in clinical remission was 58.0% (47 of 81 assessment joints) at 24 weeks, and 82.7% (67 of 81 assessment joints) at 52 weeks. Grade 0 in patients remaining in clinical remission and having a mean SJC <2 from 24 weeks to 52 weeks was 74.5% and remained after 52 weeks as well. However, in patients remaining in clinical remission and having a mean SJC ≥2, Grade 0 was only 35.3% at 24 weeks, but achieved 85.3% at 52 weeks.Grade 2 or Grade 3 were observed in total 61.7% in patients remaining in clinical remission and having a mean SJC <2, but improved substantially to 4.3% after 24 weeks.
Conclusions This study confirms that it is possible to have rapid improvement in synovitis for patients in clinical remission without SJC on TCZ treatment. Patients in clinical remission with SJC also have improvement to the same level on synovitis gradually.
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A. Sagawa. Ann Rheum Dis. 2011; 70 (Suppl3):458.
Marcin Szkudlarek et al. Arthritis & Rheumatizm.2003;48(4):955-962
Disclosure of Interest None Declared