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 were in 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 suppressing the progression of RA cervical lesions at ACR2009, EULAR 2010, 11, 12 and 13.
Objectives To investigate to determine predictive factors for suppressing radiographic progression of cervical lesions with RA receiving IFX treatment.
Methods We used IFX for treating 604 Japanese patients with active RA who fulfilled the ACR criteria in 1987. The final study cohort of 67 patients received continuous IFX treatment for 3 years from Tsurumai Biologics Communication Registry (TBCR). For evaluation of cervical lesions, the atlanto-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, 1, 2 and 3year.
Results The group of patients included 9 males and 58 females. The mean age was 54.0±12.6 years; disease duration was 10.6±9.4 years; and methotrexate dose was 7.4±1.7 mg/week. Clinical findings related to RA were as follows: swollen and tender joint count, 7.0±5.2, 8.0±5.7; patient's global assessment, 55.7±22.9mm; CRP, 3.4±2.0mg/dL; ESR, 53.4±29.2mm/h; DAS28 5.53±1.20; and MMP3, 363.4±331.3ng/mL; ADI, 3.5±1.7mm; SAC, 18.2±2.5mm; Ranawat value, 14.4±2.2mm and TSS, 60.9±51.4. When progression was defined as a change of 1 mm or more in one of the radiographic cervical lesion parameters for 3 years, the numbers of patients, who showed progression in ADI, SAC and Ranewat value were 25 (37%), 22 (33%), and 23 (34%), respectively, and the number who showed progression in at least one of these three parameters was 31 (46%). In order to determine predictive factors for suppressing progression of cervical lesions, We used Mann-Whitney U-test and ROC analysis between 36 non-progressive and 31 progressive patients. The factors which showed the significant difference were as follows: disease duration: 8.3±8.3 and 13.2±10.0 years (p=0.017); ADI: 3.0±1.4 and 4.0±2.0 mm (p=0.039); SAC 19.3±2.2 and 17.0±2.2 mm (p<0.001); Ranawat value: 15.1±1.5 and 13.6±2.6 mm (p=0.014); TSS at initiation: 49.3±50.0 and 74.3±50.3 mm (p=0.027); DAS at 3Y: 2.80±0.86 and 3.50±1.00 (p=0.002); average MMP3: 98.0±92.6 and 125.2±75.1 ng/ml (p=0.030); average DAS: 2.83±0.81 and 3.47±0.77 (p=0.001) and ΔTSS for 3 years: 0.68±0.71 and 1.73±1.04/y (p<0.001). The factors which showed the AUC0.7 were SAC at initiation, DAS at 3Y, average DAS for 3 years and ΔTSS (AUC=0.774, 0.721, 0.727 and 0.798). Also each cut-off value were 18.0, 2.70, 2.56 and 1.33 by Youden index method.
Conclusions Early treatment, sustained remission and lower ΔTSS were important factors to suppress the progression of RA cervical lesions.
Disclosure of Interest None declared