Bobbio-Pallavicini Francesca, Caporali Roberto, Alpini Claudia, Avalle Stefano, Epis Oscar M, Klersy Catherine, Montecucco Carlomaurizio
Cattedra di Reumatologia, Policlinico S Matteo, 27100 Pavia, Italy.
Ann Rheum Dis. 2007 Mar;66(3):302-7. doi: 10.1136/ard.2006.060608. Epub 2006 Nov 1.
To investigate whether rheumatoid factor isotypes and anti-cyclic citrullinated peptide (anti-CCP) antibodies are related to clinical response in patients with rheumatoid arthritis treated with tumour necrosis factor alpha (TNFalpha) inhibitors.
The study was carried out on 132 patients with advanced rheumatoid arthritis refractory to disease-modifying antirheumatic drugs. Patients were treated with infliximab (n = 63), etanercept (n = 35) or adalimumab (n = 34). All patients completed 1 year of follow-up, and 126 were evaluable for clinical response according to the disease activity score (DAS) criteria. IgM, IgA and IgG rheumatoid factors and anti-CCP antibodies were assessed by ELISA both before anti-TNFalpha treatment and 1 year later.
The DAS response was reached in 66% of evaluable patients (61% infliximab, 65% etanercept and 76% adalimumab; p = 0.354). A significant reduction in the rheumatoid factor level was reported by all treatment groups after 1 year. The frequency of positive tests for the different antibodies did not differ between responders and non-responders at baseline; however, significantly higher IgA rheumatoid factor levels were reported by the non-responder group (130.4 U/ml (interquartile range 13.8-276.7) v 24.8 U/ml (10.2-90.8); p = 0.003). A significant decrease (p<0.001) in the levels of all rheumatoid factor isotypes in the responder group was reported after 1 year of treatment, whereas anti-CCP antibody levels were not significantly affected.
According to the clinical response, anti-TNFalpha agents seem to reduce IgM, IgG and IgA rheumatoid factor levels. More interestingly, high pretreatment levels of IgA rheumatoid factor are associated with a poor clinical response to TNFalpha inhibitors.
研究类风湿因子亚型和抗环瓜氨酸肽（抗CCP）抗体与接受肿瘤坏死因子α（TNFα）抑制剂治疗的类风湿关节炎患者临床反应的相关性。
对132例对改善病情抗风湿药物治疗无效的晚期类风湿关节炎患者进行研究。患者分别接受英夫利昔单抗（n = 63）、依那西普（n = 35）或阿达木单抗（n = 34）治疗。所有患者均完成1年随访，126例患者可根据疾病活动评分（DAS）标准评估临床反应。在抗TNFα治疗前及1年后，采用酶联免疫吸附测定法（ELISA）检测IgM、IgA和IgG类风湿因子及抗CCP抗体。
66%的可评估患者达到DAS反应（英夫利昔单抗组为61%，依那西普组为65%，阿达木单抗组为76%；p = 0.354）。所有治疗组在1年后类风湿因子水平均显著降低。不同抗体阳性检测频率在基线时反应者与无反应者之间无差异；然而，无反应者组的IgA类风湿因子水平显著更高（130.4 U/ml（四分位间距13.8 - 276.7）对24.8 U/ml（10.2 - 9): p = 0.003）。治疗1年后，反应者组所有类风湿因子亚型水平均显著降低（p<0.001），而抗CCP抗体水平未受显著影响。
根据临床反应，抗TNFα药物似乎可降低IgM、IgG和IgA类风湿因子水平。更有趣的是，IgA类风湿因子治疗前高水平与对TNFα抑制剂的临床反应不佳相关。
