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Baseline serum RANKL levels may serve to predict remission in rheumatoid arthritis patients treated with TNF antagonists
  1. Isidoro González-Alvaro1,
  2. Ana M Ortiz1,
  3. Eva G Tomero2,
  4. Alejandro Balsa3,
  5. Javier Orte4,
  6. Armando Laffon1,
  7. Rosario García-Vicuña1
  1. 1
    Rheumatology Services, Hospital Universitario de la Princesa, Madrid, Spain
  2. 2
    Rheumatology Section, Hospital General de Segovia, Spain
  3. 3
    Rheumatology Services, Hospital Universitario La Paz, Madrid, Spain
  4. 4
    Rheumatology Services, Hospital Ramón y Cajal, Madrid, Spain
  1. Isidoro González-Alvaro, Rheumatology Service, Hospital Universitario de la Princesa, c/Diego de León 62, 28006 Madrid, Spain;{at}


Aims: The objective of this study was to investigate whether baseline receptor activator for nuclear factor kappaB ligand (RANKL) and osteoprotegerin (OPG) serum (s) levels can predict the therapeutic response to TNF antagonists (a-TNF).

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 28 joint count disease activity score (DAS28) ⩽2.6 and clinical response by a reduction in DAS28⩾1.2 at both 3- and 7-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), an HAQ of 1.6 (1.1 to 2.1) (median (interquartile range (IQR))) and a CRP 15 mg/l (IQR: 9 to 24). The sRANKL levels and RANKL/OPG ratio in patients that achieved remission were significantly lower at baseline than in the remaining patients at both 3 and 7 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.

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  • This work has been funded by Instituto de Salud Carlos III (FIS 04/2009 and 05/2041) and a grant from Abbott Laboratories.

  • Competing interests: None declared.

  • Abbreviations:
    TNF antagonists
    28 joint count disease activity score
    health assessment questionnaire
    interquartile range
    rheumatoid arthritis
    receptor activator for nuclear factor kappaB
    receptor activator for nuclear factor kappaB ligand