Detorakis Efstathios E, Magkanas Eleftherios, Lasithiotaki Ismini, Sidiropoulos Prodromos, Boumpas Dimitrios T, Gourtsoyiannis Nicholas, Antoniou Katerina, Raissaki Maria
Department of Radiology, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece.
Department of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece.
Clin Exp Rheumatol. 2017 Jan-Feb;35(1):43-52. Epub 2016 Oct 27.
To investigate the efficacy and safety of anti-TNF-α agent treatment compared to non-biologic DMARDs in rheumatoid arthritis patients.
82 consecutive patients, 29 males, 53 females, aged 42-79, diagnosed with RA and suitable for anti-TNF-α treatment composed two study groups: 42 with pre-existing rheumatoid arthritis-related interstitial lung disease (RA-ILD) and 40 without RA-ILD. Respective control groups consisted of 44 patients with pre-existing RA-ILD and 44 patients without RA-ILD, treated with non-biologic DMARDs. All patients underwent chest high resolution computed tomography (HRCT), pulmonary function tests (PFTs) and peripheral blood biomarkers at baseline and after one year of treatment.
There was a significant decrease of air trapping extent and bronchial wall thickening after treatment in RA-ILD and RA-non ILD study groups (p<0.05). This was accompanied by a statistically significant improvement of maximum mid-expiratory flow (MMEF75-25), RV and RV/TLC in both study groups (p<0.05). In the RA-ILD study group ILD extent scores remained unchanged after anti-TNF-α treatment. None of the RA-non ILD group developed new-onset ILD. In both RA-ILD and RA-non ILD control groups, HRCT findings and PFTs did not differ significantly at the one-year follow-up study. Methotrexate (MTX) regression analysis showed in both RA-ILD study and control groups a negative correlation between MTX dose and ILD extent score at one-year and between MTX dose and air trapping extent at baseline and after one year of treatment.
Anti-TNF-α treatment, in contrast to non-biologic DMARDs, there was an improvement of small airways disease. There was no new-onset ILD or exacerbation of preexisting-ILD, especially in patients treated with anti-TNF-α agents, supporting the efficacy and favourable safety profile of this treatment in RA patients.
探讨与非生物性改善病情抗风湿药（DMARDs）相比，抗TNF-α药物治疗类风湿关节炎患者的疗效和安全性。
82例连续患者，男性29例，女性53例，年龄42 - 79岁，诊断为类风湿关节炎且适合抗TNF-α治疗，分为两个研究组：42例患有类风湿关节炎相关间质性肺病（RA-ILD），40例无RA-ILD。各自的对照组由44例患有RA-ILD的患者和44例无RA-ILD的患者组成，接受非生物性DMARDs治疗。所有患者在基线和治疗一年后均接受胸部高分辨率计算机断层扫描（HRCT）、肺功能测试（PFTs）和外周血生物标志物检测。
RA-ILD和RA-非ILD研究组治疗后气体潴留程度和支气管壁增厚均显著降低（p<0.05）。同时，两个研究组的最大呼气中期流速（MMEF75-25）、残气量（RV）和RV/TLC均有统计学意义的改善（p<0.05）。在RA-ILD研究组中，抗TNF-α治疗后ILD程度评分保持不变。RA-非ILD组均未出现新发ILD。在RA-ILD和RA-非ILD对照组中，一年随访研究时HRCT表现和PFTs无显著差异。甲氨蝶呤（MTX）回归分析显示，在RA-ILD研究组和对照组中，MTX剂量与一年时的ILD程度评分以及基线和治疗一年后的MTX剂量与气体潴留程度之间均呈负相关。
与非生物性DMARDs相比，抗TNF-α治疗可改善小气道疾病。未出现新发ILD或原有ILD加重，尤其是接受抗TNF-α药物治疗的患者，支持该治疗在类风湿关节炎患者中的疗效和良好的安全性。
