Vol.22 No.2

Original Article

Delayed treatment with tumor necrosis factor inhibitors in incomplete responders to synthetic disease-modifying anti-rheumatic drugs shows an excellent effect in patients with very early rheumatoid arthritis with poor prognosis factors

Authors

Junko Kita1 , Mami Tamai2 , Kazuhiko Arima3 , Yoshikazu Nakashima1 , Takahisa Suzuki1 , Shin-ya Kawashiri1 , Akitomo Okada1 , Tomohiro Koga1 , Satoshi Yamasaki1 , Hideki Nakamura1 , Tomoki Origuchi4 , Toshiyuki Aramaki5, Munetoshi Nakashima5, Keita Fujikawa6, Toshiaki Tsukada6, Hiroaki Ida7, Kiyoshi Aoyagi8, Masataka Uetani9, Katsumi Eguchi10, Atsushi Kawakami1

  • Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  • Center for Health and Community Medicine, Nagasaki University, Nagasaki, Japan
  • Department of Medical Gene Technology, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  • Department of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  • The Japanese Red Cross Nagasaki Atomic Bomb Hospital, Nagasaki, Japan
  • Isahaya General Hospital, Isahaya, Japan
  • Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
  • Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  • Department of Radiology and Radiation Research, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
  • Sasebo City General Hospital, Sasebo, Japan
Received:

31 March 2011

Accepted:

2 August 2011

Published online:

6 September 2011

Full Text

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Abstract

We aimed to investigate whether delayed treatment with tumor necrosis factor (TNF) inhibitors in incomplete responders to synthetic disease-modifying antirheumatic 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.

Key words

Remission - SDAI - Synthetic DMARDs - TNF inhibitors - Very early RA