Nagasawa Hayato, Kameda Hideto, Sekiguchi Naoya, Amano Kouichi, Takeuchi Tsutomu
Department of Rheumatology, Saitama Medical Center, Saitama Medical University, 1981 Tsujido-machi, Kamoda, Kawagoe 350-8550, Japan.
Mod Rheumatol. 2009;19(2):166-72. doi: 10.1007/s10165-008-0142-0. Epub 2008 Dec 13.
We conducted a two-year prospective study to clarify the efficacy of infliximab at improving the health assessment questionnaire (HAQ) score and associated factors in 67 patients with advanced rheumatoid arthritis (RA). All patients were scheduled to receive infliximab at a dose of 3 mg/kg at weeks 0, 2, 6 and every eight weeks thereafter through to week 102, and were fully examined at the time of each infusion. Parameters of disease activity such as the serum level of C-reactive protein (CRP), the serum level of matrix metalloproteinase-3 (MMP-3) and the 28-joint disease activity score (DAS28) were obtained, and the functional capabilities of the patients were assessed using the HAQ score. The serum CRP, the MMP-3, the DAS28(CRP) level, and the mean HAQ score decreased rapidly at two weeks after the start of infliximab treatment (CRP from 3.7 to 0.9 mg/dl, MMP-3 from 362.3 to 192.8 ng/ml, DAS28(CRP) from 5.6 to 3.7, and HAQ score from 1.5 to 0.9). Compared with the baseline values, the mean progression of the modified van der Heijde (vdH)-Sharp score after one year was 4.4 +/- 5.8 (median: 3.0), and that after two years was 3.1 +/- 6.9 (median: 1.0). A 93% reduction in the rate of joint destruction, as measured using the vdH-Sharp score, was estimated after infliximab therapy. Patients with less joint damage (shorter disease duration or lower vdH-Sharp score) regained more of their daily activities. The present study demonstrated the importance of activity control before the progression of irreversible factors, such as joint destruction, for maintaining the functional capacities of RA patients.
我们进行了一项为期两年的前瞻性研究，以阐明英夫利昔单抗对改善67例晚期类风湿关节炎（RA）患者的健康评估问卷（HAQ）评分及相关因素的疗效。所有患者计划在第0、2、6周接受3mg/kg剂量的英夫利昔单抗治疗，此后每8周一次，直至第102周，并在每次输注时进行全面检查。获取疾病活动参数，如血清C反应蛋白（CRP）水平、血清基质金属蛋白酶-3（MMP-3）水平和28关节疾病活动评分（DAS28），并使用HAQ评分评估患者的功能能力。英夫利昔单抗治疗开始后两周，血清CRP、MMP-3、DAS28（CRP）水平和平均HAQ评分迅速下降（CRP从3.7降至0.9mg/dl，MMP-3从362.3降至192.8ng/ml，DAS28（CRP）从5.6降至3.7，HAQ评分从1.5降至0.9）。与基线值相比，改良范德海伊德（vdH）-夏普评分一年后的平均进展为4.4±5.8（中位数：3.0），两年后的平均进展为3.1±6.9（中位数：1.0）。英夫利昔单抗治疗后，使用vdH-夏普评分测量的关节破坏率估计降低了93%。关节损伤较少（病程较短或vdH-夏普评分较低）的患者恢复了更多的日常活动。本研究表明，在关节破坏等不可逆因素进展之前控制活动对于维持RA患者的功能能力很重要。
