Background Rheumatoid arthritis (RA) is a chronic inflammatory joint disease with a prevalence ranging from 0,5-1% in the general population, associated with premature mortality, disability and compromised quality of life. The classification criteria for RA (American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis – the 2010 ACR/EULAR classification criteria for RA) was introduced in 2010 as a tool with high sensitivity and specificity for diagnosing RA, including anti-cyclic citrullinated peptide antibodies (ACPA) and rheumatoid factor (RF).
Rituximab (RTX) has been shown to be an effective RA treatment for use in anti tumor necrosis alpha (TNF-alpha) refractory disease.
Objectives The aim of the study is to establish the dynamic correlation of ACPA and RF patterns with Disease Activity Score 28 – C reactive protein (DAS28-CRP), after the third completed cure.
Methods The study included 45 active RA (DAS28 >5,1) subjects with a mean age of 48 years, 88,8% were women with mean disease duration of 7,1 years; all subjects had failed to at least one anti-TNF-alpha regimen and were RTX naive. All the patients were RF-positive, 91,1% were ACPA positive at the inclusion testing and DAS28 was determined each time one day prior the RTX cure. A moderate response was considered as a decrease of DAS28 of at least 1.2 from the prior value.
Results Moderate response to RTX was observed in 41 cases (91,1%). 33 subjects from responders (80,5%) showed also a significant decrease (more than 50% from initial testing levels) of both RF and ACPA. The number of previous anti-TNF agents (p=0.003), RF positivity (p<0.0001) and ACPA positivity (p=0.003) were associated with EULAR moderate response after the third RTX cure by univariate analysis. Multivariate analysis confirmed that a lower number of anti-TNF agents failed before RTX and both RF and ACPA positivity - were the selected variables associated with a moderate response. Significant decrease of both RF and ACPA was correlated with EULAR moderate response both in the univariate and in the multivariate analysis.
Conclusions RF and ACPA positive RA patients with a lower number of previously failed TNF blockers may be the best candidates to RTX. Decrease of RF and ACPA levels is significantly correlated with the achievement of a moderate response to RTX.
Disclosure of Interest None Declared
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