Background The aim of therapy rheumatoid arthritis (RA) is the achievement of remission of the disease and slowing destruction of the joints. Tocilizumab (TCZ), anti-interleukin-6 receptor monoclonal antibody was used in treatment of active RA. TCZ has a rapid positive effect on the clinical manifestations and laboratory disoders, slowing destruction of joints in RA.
Objectives To assess the effect of TCZ on synovitis on MRI of bilateral wrist and metacarpophalangeal joints in accordance with the OMERACT RA MRI scoring system (RAMRIS).
Methods 43 adult patients with active RA were enrolled in the open label, phase IV trial to confirm the effectiveness and safety TCZ. Average age (median, interquartile range) 50,5 (43,0–55,0) years, duration of RA 56,5 (23,0–81,0) months, RF (+) 81%, ACCP (+) 77%. Patient had to be naive to biologics and have moderate to severe active RA (based on the 1987 ACR criteria). Patients remained on stable doses of disease-modifying antirheumatic drugs and received TCZ 8 mg/kg every 4 weeks for 24 weeks (total 6 infusions). Disease remission was assessed according to the criteria of EULAR and EULAR/ACR 2011. MRI performed at 0 and 24 weeks of observation.
Results Before therapy indices DAS28 (6,4; 5,9–7,0), CDAI (41,5; 32,0–53,0) and SDAI (45,0; 36,2–57,0) corresponded to high activity of RA. The value of DAS28 to 24 weeks of treatment was 2,1; 1,3–2,8, p<0.05. Indicators SDAI and CDAI up to 24th week match the low activity of RA (4,4; 2,0–8,8 and 3,6; 1,4–7,6, respectively). Remission was achieved by 24 weeks of treatment on indices: DAS28<2.6 for 30 patients (71%), CDAI<2.8 to 14 (33%), SDAI<3.3 to 13 (31%) and according to the criteria of ACR/EULAR 2011 (Boolean) – 10 (24%). MRI of the bilateral wrist and metacarpophalangeal joints was performed for patients who achieved remission according to the DAS28 criteria (n=27) and Boolean (n=10). Synovitis was detected in 81.5% and 80%, osteitis in 11.1% and 10% of patients, respectively.
Conclusions Despite the pronounced clinical effect of TCZ in patients with RA and remission according to the criteria of DAS28 and ACR/EULAR, synovitis was detected in most patients. MRI examination allows to observe the patients during the therapy to achieve complete remission of the disease.
Disclosure of Interest None declared
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