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Baseline serum RANKL levels may serve to predict remission in rheumatoid arthritis patients treated with TNF antagonists
  1. Isidoro González-Alvaro ({at}
  1. Hospital Universitario La Princesa, Spain
    1. Ana M Ortiz (lanult{at}
    1. Hospital Universitario La Princesa, Spain
      1. Eva G Tomero (tomeroeva{at}
      1. Hospital Universitario La Princesa, Spain
        1. Alejandro Balsa (abalsa.hulp{at}
        1. Hospital Universitario La Paz, Spain
          1. Javier Orte (javier_orte{at}
          1. Hospital Ramon y Cajal, Spain
            1. Armando Laffon (alaffon.hlpr{at}
            1. Hospital Universitario La Princesa, Spain
              1. Rosario García-Vicuña (vicuna1{at}
              1. Hospital Universitario La Princesa, Spain


                Purpose: The objective of this study was to investigate whether baseline RANKL and OPG serum (s) levels can predict the therapeutic response to TNF antagonists (a-TNF).

                Patients and methods: We studied 75 rheumatoid arthritis patients (81% female) with a longstanding refractory disease. The variables of disease activity, physical function and sRANKL and sOPG levels were determined before and after both 12-14 and 28-30 weeks of a-TNF therapy (65 adalimumab, 10 infliximab). Remission was defined by a DAS28≤2.6 and clinical response by a reduction of DAS28≥1.2 both at three and seven month follow-up visits.

                Results: In most patients disease activity was severe as reflected by a baseline DAS28 score of 5.9±1 (mean±sd), a HAQ of 1.6 [1.1-2.1] (median [interquartile range (IQR)]) and a CRP 15 mg/L [IQR:9-24]. The sRANKL levels and RANKL/OPG ratio in patients that achieved remission were significantly lower at baseline than in the remaining patients both at three and seven months of follow-up. The sOPG levels correlated with the HAQ and the physician's disease assessment and diminished significantly after a-TNF treatment. However, no significant association was detected between the therapeutic response profile and sOPG levels.

                Conclusions: These data suggest that in patients receiving a-TNF treatment lower serum levels of RANKL and RANKL/OPG ratio may serve to predict remission.

                • RANKL
                • TNF blockade
                • osteoprotegerin
                • predictor factors
                • rheumatoid arthritis

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