Background Cervical lesions are known to occur at high frequency as a complication of rheumatoid arthritis (RA). reatment with biological agents are more clinically effective than the DMARDs that were in use previously, in particular, with their efficacy in suppressing joint destruction having been emphasized. We reported the efficacy of infliximab, anti-tumor necrosis factor antibodies for inhibiting the radiographic progression of RA cervical lesions at ACR2009, EULAR 2010 and 11. However there is still no studies of efficacy of against RA cervical lesions of Tocilizumab(TCZ), anti-interleukin 6 receptor antibody. Therefore, we carried out the present study, which was a prospective investigation in patients receiving TCZ, in order to elucidate the efficacy of TCZ for inhibiting the radiographic progression of RA cervical lesions.
Methods We used TCZ for treating 270 Japanese patients with active RA who fulfilled the ACR criteria in 1987.Treatment with TCZ was initiated between July 2008 and December 2010; the final study cohort of 36 patients received ontinuous TCZ treatment for at least 1 year. he TCZ dose was 8 mg/kg. The later doses were administered every 4 weeks up to Week 52. For evaluation of cervical esions, the tlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat value were measured by plain lateral radiographs in the flexion position, at initiation and Week 52. For evaluation of hand joint lesions, simple X-radiography of both surfaces of the hands was carried out, and joint destruction was evaluated using the Sharp/Van der Heijde Score (SHS) at initiation and Week 52.
Results The mean ADI changed from 3.3±1.7 mm at initiation to 3.6±1.9 mm after 1 year (p=0.002). The mean SAC changed from 19.0±2.7 to 18.8±2.8 mm over the same period (p=0.003). The mean Ranawat value changed from 5.1±2.4 to 14.9±2.5 mm over the same period (p=0.003). The mean TSS changed from 64.8±53.5 at initiation to 66.4±54.1 after 1 year (p<0.001). t Week 52, the disease activity of all patients on the basis of the CDAI criteria were remission, low, moderate and high in 9, 14, 11, 2 patients, respectively. In the remission patients (n=9) and the low, moderate and high patients (n=27), the respective changes in cervical lesion parameters in 1 year were as follows: ADI: 0 and 0.41±0.57 mm (p=0.035); SAC: 0 and -0.33±0.48 mm (p=0.049); and Ranawat value: 0 and -0.33±0.48 mm (p=0.049). Furthermore we investigated the changes in ADI, SAC, Ranawat value from baseline to Week 52 between non-progressive (ΔTSS≤0) and progressive patients (ΔTSS≥1) in SHS. In the non-progressive (n=11) and progressive patients (n=25), the respective changes in cervical lesion parameters in 1 year were as follows: DI: 0 and 0.44±0.58 mm (p=0.015); SAC: 0 and -0.36±0.49 mm (p=0.024); and Ranawat value: 0 and -0.36 ±0.49 mm (p=0.024).
Conclusions TCZ treatment can be used to suppress the progression of RA cervical lesions, as well as hand and foot oints lesions. 1 year after initiation, the cervical lesion did not progress at all for the patients that a hand joint destruction did not progress and the remission patients at Week 52.
Disclosure of Interest None Declared