Background Cervical lesions are known to occur at high frequency as a complication of rheumatoid arthritis (RA). Treatment with Anti-TNFα agents are more clinically effective than the DMARDs that werein use previously, in particular, with their efficacy in suppressing joint destruction having been emphasized. However, most clinical studies on the efficacy of biological agents in suppressing joint destruction in the hands and feet. Therefore, we reported the efficacy of infliximab (IFX) for inhibiting the radiographic progression of RA cervical lesions at ACR2009, EULAR 2010,11 and 12.
Objectives To investigatethe efficacy of IFX for inhibiting theradiographic progression of RA cervical lesions over three years.
Methods We used IFX for treating 604 Japanese patients with active RA who fulfilled the ACR criteria in 1987. Treatment with IFX was initiated between November 2003 and January 2010; the final study cohort of 45 patients receivedcontinuous IFX treatment for at least 3 years. For evaluation of cervicallesions, theatlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat value weremeasured by plain lateral radiographs in the flexion position, at initiation, 1, 2 and 3year. For evaluation of hand jointlesions, simple X-radiography of both surfaces of the hands was carried out, and joint destruction was evaluated usingthe Sharp/Van der Heijde Score (SHS).
Results The mean ADI changed from 3.5 ± 1.8 mm at initiation to 4.0 ± 2.0 mm after 3 years (p< 0.001). The mean SACchanged from 17.7 ± 2.2 to 17.1 ± 2.6mm over the same period (p< 0.001). The mean Ranawat value changed from14.1 ± 2.3 to 13.7 ± 2.5 mm over the same period (p< 0.001). The mean TSS changed from 57.2 ± 47.8 at initiation to61.2 ± 48.4 after 3 years (p < 0.001). At 3 year, the disease activity of all patients on the basis of the DAS28 criteria were remission, low, moderate and high in 15, 9, 18, 3 patients, respectively. In the remission patients (n = 15) and the low, moderate and high patients (n = 30), the respective changes in cervical lesion parameters in 3 year were as follows: ADI: 0.27 ± 0.59 and 0.70 ± 0.88 mm (p = 0.064); SAC: -0.27 ± 0.59 and −0.77 ± 0.97 mm (p = 0.043); and Ranawat value: -0.20 ± 0.41 and −0.50 ± 0.57 mm (p = 0.080). Furthermore we investigated the changes in ADI, SAC, Ranawat value from baseline to 3 year between non-progressive group (ΔTSS≤0.5/y) and progressive group (ΔTSS>0.5/y) in SHS. In the non-progressive group (n=12) and progressive group (n = 33), the respective changes in cervical lesion parameters in 3 years were as follows:ADI: 0 and 0.76 ± 0.87 mm (p < 0.002); SAC: 0 and −0.82 ± 0.95 mm (p = 0.001); and Ranawat value: 0 and −0.55 ± 0.56 mm (p = 0.002).
Conclusions IFX treatment can be used to suppress the progression of RA cervical lesions, as well as hand and footjoints lesions. It is possible that response to IFX could be used to predict the progression of RA cervical lesions. 3 year after initiation, the cervical lesion did not progress at all for the patients that a hand joint destruction was prevented as well as the results of one and two year follow-up.
Disclosure of Interest: None Declared