Jonsdottir T, Forslid J, van Vollenhoven A, Harju A, Brannemark S, Klareskog L, van Vollenhoven R F
Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
Ann Rheum Dis. 2004 Sep;63(9):1075-8. doi: 10.1136/ard.2003.018093. Epub 2004 Apr 5.
To determine the frequency and clinical impact of anticardiolipin antibodies (aCL) in patients with rheumatoid arthritis treated with infliximab and etanercept.
121 patients from the Stockholm tumour necrosis factor alpha (TNFalpha) follow up registry (STURE) treated with infliximab or etanercept were studied.
At baseline 9/65 (14%) infliximab and 10/56 (18%) etanercept treated patients had positive aCL. After 3 months the frequencies of aCL positivity were 29% (p<0.05 compared with baseline) and 27%, respectively, and after 6 months 28% and 25%. Increases were seen for both IgG and IgM aCL. Increasing age, a higher number of prior DMARDs, and higher DAS28 were predictors for the development of aCL. In the infliximab treated patients, 26/30 (87%) aCL(-) but only 7/14 (50%) aCL(+) patients met the ACR20 criteria (p<0.05), and the frequency of treatment limiting infusion reactions in the aCL(+) patients was higher than expected (17%). aCL positivity in the etanercept treated patients did not show such a clinical correlate. Four patients had thromboembolic events, of whom two were aCL(+) and two aCL(-).
Frequencies of both IgM and IgG aCL positivity increase in patients treated with these TNFalpha antagonists for 3 months or longer. Increasing age, a greater number of prior DMARDs and a greater disease activity at baseline are predictors for the development of aCL. The development of aCL during treatment with infliximab, but not etanercept, is associated with worse clinical results and more frequent serious infusion reactions. aCL are an important class of autoantibodies associated with TNFalpha blocking therapy.
确定接受英夫利昔单抗和依那西普治疗的类风湿关节炎患者中抗心磷脂抗体（aCL）的出现频率及其临床影响。
对来自斯德哥尔摩肿瘤坏死因子α（TNFα）随访登记处（STURE）的121例接受英夫利昔单抗或依那西普治疗的患者进行了研究。
基线时，接受英夫利昔单抗治疗的65例患者中有9例（14%）aCL呈阳性，接受依那西普治疗的56例患者中有10例（18%）aCL呈阳性。3个月后，aCL阳性率分别为29%（与基线相比p<0.05）和27%，6个月后分别为28%和25%。IgG和IgM aCL均出现增加。年龄增加、既往使用过更多的改善病情抗风湿药（DMARDs）以及更高的疾病活动度评分（DAS28）是aCL产生的预测因素。在接受英夫利昔单抗治疗的患者中，30例aCL阴性患者中有26例（87%）达到美国风湿病学会（ACR）20标准，而14例aCL阳性患者中只有7例（50%）达到该标准（p<0.05），并且aCL阳性患者中导致治疗受限的输液反应频率高于预期（17%）。依那西普治疗患者的aCL阳性并未显示出此类临床相关性。有4例患者发生了血栓栓塞事件，其中2例aCL阳性，2例aCL阴性。
接受这些TNFα拮抗剂治疗3个月或更长时间的患者中，IgM和IgG aCL阳性率均升高。年龄增加、既往使用更多DMARDs以及基线时更高的疾病活动度是aCL产生的预测因素。在使用英夫利昔单抗而非依那西普治疗期间aCL的产生与较差的临床结果和更频繁的严重输液反应相关。aCL是与TNFα阻断治疗相关的一类重要自身抗体。
