Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Mod Rheumatol. 2012 Apr;22(2):195-201. doi: 10.1007/s10165-011-0511-y. Epub 2011 Sep 6.
We aimed to investigate whether delayed treatment with tumor necrosis factor (TNF) inhibitors in incomplete responders to synthetic disease-modifying anti-rheumatic drugs (DMARDs) was effective among patients with very early rheumatoid arthritis (RA) with poor prognosis factors. We examined 22 patients with very early RA who were positive for anti-cyclic citrullinated peptide antibodies or IgM-rheumatoid factor. The mean disease duration at entry was 14.1 weeks. A treat-to-target strategy, aiming at simplified disease activity index (SDAI) remission, was initiated with synthetic DMARDs. SDAI remission was not achieved in 9 of the 22 patients with synthetic DMARDs alone, and TNF inhibitors were added in these patients. SDAI values in these 9 patients were further examined for the following 6 months. The TNF inhibitors (infliximab 8, etanercept 1) were added at a mean interval of 34.1 weeks after the initiation of synthetic DMARDs. SDAI remission was achieved in 4 of the 9 patients (44.4%) at 3 months and in 8 of the 9 patients (88.9%) at 6 months after the introduction of the TNF inhibitors. Radiographic damage had not progressed in these patients. Delayed treatment with TNF inhibitors is effective and tolerable for patients with very early RA with poor prognosis factors.
我们旨在探讨在预后不良的早期类风湿关节炎（RA）患者中，对于合成改善病情抗风湿药物（DMARDs）不完全应答的不完全应答者，延迟使用肿瘤坏死因子（TNF）抑制剂是否有效。我们检查了 22 例抗环瓜氨酸肽抗体或 IgM-类风湿因子阳性的早期 RA 患者。入组时的平均病程为 14.1 周。采用简化疾病活动指数（SDAI）缓解的达标治疗策略，起始使用合成 DMARDs。9 例单独使用合成 DMARDs 的患者未达到 SDAI 缓解，这些患者加用了 TNF 抑制剂。进一步检查了这 9 例患者的 SDAI 值，随访 6 个月。TNF 抑制剂（英夫利昔单抗 8 例，依那西普 1 例）在起始合成 DMARDs 后平均 34.1 周时加用。在 TNF 抑制剂引入后 3 个月时，9 例患者中有 4 例（44.4%）达到 SDAI 缓解，6 个月时 8 例（88.9%）达到 SDAI 缓解。这些患者的放射学损伤没有进展。对于预后不良的早期 RA 患者，延迟使用 TNF 抑制剂是有效且耐受良好的。
