Department of Rheumatology and Immunology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwaizheng Street, Donghu District, Nanchang City, Jiangxi Province, 330006, China.
Arthritis Res Ther. 2024 Oct 31;26(1):186. doi: 10.1186/s13075-024-03426-2.
Rheumatoid arthritis (RA) is a clinically heterogeneous and complex autoimmune disease, making the prediction of therapeutic responses a significant challenge. This study aims to assess the role of clinical and synovial biomarkers in predicting poor response to adalimumab treatment in RA patients.
This single-center prospective study included 56 RA patients who had an inadequate response to methotrexate (MTX). At baseline, comprehensive assessments including complete blood count, liver and kidney function tests, blood glucose levels, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-citrullinated protein antibody (ACPA), as well as counts of swollen and tender joints, Health Assessment Questionnaire (HAQ) score, pain visual analogue scale (VAS) scores, and DAS28-CRP scores were conducted. Synovial biopsies were performed, followed by an efficacy evaluation at 12 weeks of adalimumab treatment. Patients not meeting the ACR20 criteria were classified into the non-responder group, with the remainder categorized as the responder group.
Out of the participants, 24 (42.9%) failed to achieve ACR20 with adalimumab treatment. Non-responders exhibited higher infiltration of plasma cells in the synovium. Multivariate logistic regression analysis identified the presence of plasma cells as an independent risk factor for inadequate response to adalimumab.
Inadequate responses to adalimumab in RA patients were associated with increased plasma cell infiltrations in the synovium. These findings suggest a promising target for tailored therapies in rheumatoid arthritis.
类风湿关节炎（RA）是一种临床表现异质性和病理过程复杂的自身免疫性疾病，这使得预测其治疗反应变得极具挑战。本研究旨在评估临床和滑膜生物标志物在预测 RA 患者对阿达木单抗治疗反应不佳中的作用。
这是一项单中心前瞻性研究，共纳入 56 例对甲氨蝶呤（MTX）反应不足的 RA 患者。在基线时，进行了全面评估，包括全血细胞计数、肝肾功能检查、血糖水平、红细胞沉降率（ESR）、C 反应蛋白（CRP）、类风湿因子（RF）、抗瓜氨酸蛋白抗体（ACPA），以及肿胀和压痛关节计数、健康评估问卷（HAQ）评分、疼痛视觉模拟评分（VAS）和 DAS28-CRP 评分。进行滑膜活检，然后在阿达木单抗治疗 12 周时进行疗效评估。未达到 ACR20 标准的患者被归类为无应答组，其余患者归类为应答组。
在参与者中，有 24 人（42.9%）在接受阿达木单抗治疗后未达到 ACR20。无应答者的滑膜中浆细胞浸润更多。多变量逻辑回归分析确定浆细胞存在是阿达木单抗治疗反应不足的独立危险因素。
RA 患者对阿达木单抗的反应不足与滑膜中浆细胞浸润增加有关。这些发现为类风湿关节炎的靶向治疗提供了一个有希望的目标。
