A Three Year Retrospective Analysis Of Anti-Tnf Treatment Outcomes In Rheumatoid Arthritis And Ankylosing Spondylitis Patients

Abstract

Abstract

Background/Aims:To investigate the effectiveness and reliability of anti-TNF treatment in Ankylosing Spondylitis-Rheumatoid arthritis patients.

Methods:180 patients (110 Rheumatoid arthritis (RA) patients diagnosed according to 1987 American Rheumatism Association criteria, 70 Ankylosing Spondylitis (AS) patients diagnosed according to Modified NewYork Criteria) admitted to the hospital for arthritis and related compliants who were followed up and treated with anti-TNF treatment in the department of Rheumatology&Immunology from 2009 to 2011. We enrolled 100 patients with RA (76 women, 24 men) and 60 patients with AS (16 women, 44 men) to the study, excluded 20 patients according to the exclusion criterias. The response of the patients to the anti-TNF treatment was evaluated by comparing the clinical parameters BASDAI, DAS28 and VAS score; and laboratory measurements of erytrocyte sedimentation rate, C-reactive protein levels of rheumatoid arthritis and ankylosing spondylitis before and six months after the treatment.

Results:After the six months of anti Tnf treatment, BASDAI score for AS, DAS28 score for RA, VAS, ESR and CRP levels for both diseases showed a statistically significant improvement, moreover it was determined that demographic variations did not affect these values.

Conclusions: Our results demonstrated that anti-TNF treatment is safe and effective treatment modality in patients with Ankylosing Spondylitis and Rheumatoid arthritis. These findings are short-term results of a study, and therefore future studies with larger patient series and long term follow-up are needed to look at outcomes of long term therapies.

Keywords

• ankylosing spondylitis,rheumatoid arthritis,anti-TNF treatment,outcomes

References

1. 1. Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet, 2001;358(9285):903-11.
2. 2. Braun J, Sieper J. Ankylosing Spondylitis. Lancet 2007; 369: 1379-90.
3. 3. Scott DL, Kingsley GH. Tumor necrosis factor inhibitors for rheumatoid arthritis. N Engl J Med, 2006; 355: 704-12.
4. 4. M.J. Larché, S.M. Sacre, B.M. Foxwell. Pathogenic role of TNFα in rheumatoid arthritis. Drug discovery today: Disease Mechanisms. 2005; 23: 367-375.
5. 5. Michael R. Ehrenstein, Jamie G. Evans, Animesh Singh, Samantha Moore, Gary Warnes, David A. Isenberg, et al. Compromised Function of Regulatory T Cells in Rheumatoid Arthritis and Reversal by Anti-TNF Therapy. J Exp Med. 2004; 200: 277-285.
6. 6. Taylor PC, Steuer A, Gruber J, Cosgrove DO, Blomley MJ, Marsters PA, et al. Comparison of Ultrasonographi Assessment of Synovitis and Joint Vascularity With Radiographic Evaluation in a Randomized, Placebo-Controlled Study of Infliximab Therapy in Early Rheumatoid Arthritis. Arthitis & Rheumatism. 2004; 50: 44-48.
7. 7. J. Braun, J. Xiang, J. Brandt, H. Maetzel, H. Haibel, P. Wu, et al. Treatment of spondyloarthropathies with antibodies against tumour necrosis factor a first clinical and laboratory experiences. Ann Rheum Dis. 2000; 59: 38-42
8. 8. Sonel B, Tutkak H, Düzgün N. Serum levels of IL-1beta, TNF-alpha, IL-8, and acute phase proteins in seronegative spondyloarthropathies. Joint Bone Spine. 2002; 69.463-7.

9. 9. Mansour M, Cheema GS, Naguwa SM, Greenspan A, Borchers AT, Keen CL, et al. Ankylosing Spondylitis: A Contemporary Perspective on Diagnosis and Treatment. Semin Arthritis Rheum. 2007; 36: 210-223.
10. 10. Davis JC Jr. Understanding the Role of Tumor Necrosis Factor Inhibition in Ankylosing Spondylitis. Semin Arthritis Rheum. 2004; 34: 668-677.
11. 11. Woolley DE, Tetlow LC. Mast cell activation and its relation to proinflammatory cytokine production in the rheumatoid lesion. Arthritis Res. 2000, 2:65–74.
12. 12. Gabriel SE. The epidemiology of rheumatoid arthritis. Rheum Dis Clin North Am. 2001; 27: 269-81.
13. 13. Padyukov L, Silva C, Stolt P, Alfredsson L, Klareskog L. A gene-environment interaction between smoking and shared epitope genes in HLA-DR provides a high risk of seropositive rheumatoid arthritis. Arthritis Rheum. 2004; 50: 3085-92.
14. 14. Mielants H, Veys EM, Goemaere S, Goethals K, Cuvelier C, De Vos M. Gut inflammation in the spondyloarthropathies: clinical, radiologic, biologic and genetic features in relation to the type of histology. A prospective study. J Rheumatol. 1991, 18(10): 1542-51.
15. 15. Will R, Edmunds L, Elswood J, Calin A. Is there sexual inequalty in ankylosingspondylitis? A study of 498 women and 12002 men. J Rheumatol. 1990, 17:1649-52.
16. 16. Bodur H, Ataman S, Akbulut L, Evcik D, Kavuncu V, Kaya T, et al. Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis. Clin Rheumatol. 2008, 27: 1119-25.
17. 17. Konttinen L, Tuompo R, Uusitalo T, Luosujärvi R, Laiho K, Lähteenmäki J, et al. Anti-TNF therapy in the treatment of ankylosing spondylitis: the Finnish experience. Clin Rheumatol. 2007, 26:1693-700.
18. 18. Van der Heijde D, Dijkmans B, Geusens P, Sieper J, DeWoody K, Williamson P, et al. Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthritis Rheum. 2005, 52: 582-91.
19. 19. Van der Heijde D, Kivitz A, Schiff MH, Sieper J, Dijkmans BA, Braun J, et al. Efficacy and safety of adalimumab in patients with ankylosing spondylitis: results of a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2006, 54: 2136-46.
20. 20. Breedveld FC, Weisman MH, Kavanaugh AF, Cohen SB, Pavelka K, van Vollenhoven R, et al. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum. 2006;54(1):26-37.
21. 21. Emery P, Breedveld FC, Hall S, Durez P, Chang DJ, Robertson D, et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet. 2008;2;372(9636):375-82. Epub 2008 Jul 16.
22. 22. Smolen JS, Han C, Bala M, Maini RN, Kalden JR, van der Heijde D, et al. ATTRACT Study Group. Evidence of radiographic benefit of treatment with infliximab plus methotrexate in rheumatoid arthritis patients who had no clinical improvement: a detailed subanalysis of data from the anti-tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study. Arthritis Rheum. 2005;52(4):1020-30.
23. 23. Weinblatt ME, Keystone EC, Furst DE, Kavanaugh AF, Chartash EK, Segurado OG. Long term efficacy and safety of adalimumab plus methotrexate in patients with rheumatoid arthritis: ARMADA 4 year extended study. Ann Rheum Dis 2006; 65: 753–759.