Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, 28-Czerwca 1956 Street 135/147, 61-545, Poznan, Poland.
Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland.
Inflammopharmacology. 2019 Aug;27(4):679-683. doi: 10.1007/s10787-019-00564-x. Epub 2019 Jan 24.
Tumor necrosis factor-alpha (TNFα) inhibitors have significantly improved the outcomes of treatment for rheumatoid arthritis (RA). In the present study, we aimed to determine whether serum levels of TNFα during therapy with TNFα inhibitors do really reflect the disease activity and correspond to the intensity of pain experienced.
Thirty RA patients were examined before and after 12 weeks of routine therapy with TNFα inhibitors. Serum levels of TNFα were measured with a high-sensitivity immunoassay and related to patients' clinical and biochemical status. Disease activity was assessed by the modified disease activity score (DAS28).
A median relative change in TNFα was 13%. The patients were stratified according to whether the relative change in serum TNFα after therapy was above or below this median value. The patients from both subgroups did not differ in baseline characteristics and response to therapy. However, the patients in whom serum TNFα increased after therapy above the median value had more tender joints after treatment than patients from the other group. Consequently, the number of tender joints after the treatment correlated with absolute TNFα concentrations at this time (r = 0.37; p = 0.049) and the magnitude of changes in serum TNFα correlated with a change in the number of tender joints (r = - 0.48; p = 0.008).
Circulating TNFα levels did not decrease in RA patients treated with TNFα inhibitors, despite clinical and biochemical improvement. It is possible, that circulating TNFα is responsible for the persistence of joint pain in this group of patients.
肿瘤坏死因子-α（TNFα）抑制剂显著改善了类风湿关节炎（RA）的治疗效果。本研究旨在确定 TNFα 抑制剂治疗期间血清 TNFα 水平是否确实反映了疾病活动度，并与患者所经历的疼痛强度相对应。
30 例 RA 患者在接受 TNFα 抑制剂常规治疗 12 周前后接受检查。采用高敏免疫分析法检测血清 TNFα 水平，并与患者的临床和生化状况相关联。疾病活动度采用改良疾病活动评分（DAS28）进行评估。
TNFα 的中位数相对变化为 13%。根据治疗后血清 TNFα 的相对变化是否高于或低于中位数，将患者分为两组。两组患者在基线特征和治疗反应方面无差异。然而，治疗后血清 TNFα 升高超过中位数的患者在治疗后触诊关节数比另一组患者多。因此，治疗后触诊关节数与此时的 TNFα 绝对浓度相关（r=0.37；p=0.049），且血清 TNFα 的变化幅度与触诊关节数的变化相关（r=-0.48；p=0.008）。
尽管临床和生化改善，但接受 TNFα 抑制剂治疗的 RA 患者的循环 TNFα 水平并未降低。在这组患者中，循环 TNFα 可能是关节疼痛持续存在的原因。
