The clinical course of patients with rheumatoid arthritis who underwent orthopaedic surgeries under disease control by tofacitinib
The clinical course of patients with rheumatoid arthritis who underwent orthopaedic surgeries under disease control by tofacitinib
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DOI：
10.1080/14397595.2018.1427431
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发表时间：
2018-01-01
影响因子：
2.2
通讯作者：
Ozaki, Toshifumi
中科院分区：
文献类型：
--
作者：
Nishida, Keiichiro;Harada, Ryozo;Ozaki, Toshifumi
托法替尼（TOF）是JAK 1和JAK 3信号通路的首个小分子抑制剂，据报道可有效抑制类风湿性关节炎（RA）的滑膜炎症[1，2]。2013年，日本厚生劳动省批准TOF用于治疗RA。EULAR 2016年关于使用靶向合成和生物疾病缓解抗风湿药物（tsDMARD和bDMARD）管理RA的建议更新包括，当I期治疗因缺乏疗效和/或毒性而失败时，在同一系列bDMARD中使用JAK抑制剂作为II期治疗的一种选择[3]。随着TOF在RA患者中的广泛使用，需要手术干预的患者数量可能会增加。然而，目前，关于围手术期停止TOF的信息很少。我们回顾性分析了9例RA患者在冈山大学医院和仓敷医院接受骨科手术的病例。本研究已获得我们各自研究所伦理委员会的批准。术前患者特征总结见表1。患者包括7名女性和2名男性，平均年龄为61.4岁（范围33-85），手术时平均病程为19年（范围5-30）。每例患者在使用TOF前至少经历了两次bDMARD的原发性或继发性失败。尽管日本流变学学会（JCR）关于TOF上市后监测的指南（URL：http：//www.龙町com/info/guideline_tofacitinib. html）建议在对超过8 mg/wk的甲氨蝶呤（MTX）表现出不充分反应的患者中使用TOF，我们的6名患者由于副作用而不能耐受MTX并停止使用。5例患者同时使用泼尼松龙，无患者有糖尿病作为术前并发症。7名患者接受TOF治疗，
Tofacitinib (TOF) is the first small-molecule inhibitor of the JAK1 and JAK3 signalling pathways, and has been reported to effectively suppress the synovial inflammation of rheumatoid arthritis (RA)[1, 2]. In 2013, the Japanese Ministry of Health, Labour and Welfare approved TOF for the treatment of RA. The EULAR recommendation 2016 update for the management of RA with targeted synthetic and biological disease-modifying anti-rheumatic drugs (tsDMARDS and bDMARDs) included the use of JAK inhibitors as an option for phase II treatment, in the same line of bDMARDs, when phase I treatment has failed due to lack of efficacy and/or toxicity [3]. With the widespread use of TOF among RA patients, the number of patients who require surgical intervention is likely to increase. However, at present, little information is available regarding perioperative discontinuation of TOF.We retrospectively reviewed the cases of nine patients with RA who underwent orthopaedic procedures at Okayama University Hospital and Kurashiki Sweet Hospital. The current study has been approved by the Ethics Committees of our respective institutes. The patientse characteristics before surgery are summarized in Table 1. Patients comprised seven women and two men, with an average age of 61.4 years (range 33-85), and their average disease duration was 19 years (range 5-30) at the time of surgery. Every patient had experienced at least two primary or secondary failures of bDMARDs before use of TOF. Although the guidelines from the Japan College of Rheumatology (JCR) for post-marketing surveillance of TOF (URL: http://www. ryumachi-jp. com/info/guideline_tofacitinib. html, in Japanese) suggested the use of TOF in patients who showed an inadequate response to more than 8mg/wk of methotrexate (MTX), six of our patients were unable to tolerate MTX due to side effects and discontinued its use. Five patients used concomitant prednisolone, and no patients had diabetes mellitus as a preoperative complication. Seven patients were receiving treatment with TOF at