Delayed treatment with tumor necrosis factor inhibitors in incomplete responders to synthetic disease-modifying anti-rheumatic drags shows an excellent effect in patients with very early rheumatoid arthritis with poor prognosis factors
Delayed treatment with tumor necrosis factor inhibitors in incomplete responders to synthetic disease-modifying anti-rheumatic drags shows an excellent effect in patients with very early rheumatoid arthritis with poor prognosis factors
复制标题
对合成缓解病情抗风湿药物不完全反应的患者延迟使用肿瘤坏死因子抑制剂治疗，对于预后不良的极早期类风湿性关节炎患者显示出良好的效果
DOI：
10.1007/s10165-011-0511-y
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发表时间：
2011
期刊：
影响因子：
2.2
通讯作者：
Kawakami A
中科院分区：
文献类型：
--
作者：
Kita J;Tamai M(筆頭共著者);ArimaK;Nakashima Y;Suzuki T;Kawashiri SY;Okada A;Koga T;Yamasaki S;Nakamura H;Origuchi T;Aramaki T;Nakashima M;Fujikawa K;Tsukada T;Ida H;Aoyagi K;Uetani M;Eguchi K;Kawakami A
我们的目的是研究肿瘤坏死因子（TNF）抑制剂对合成疾病改善抗风湿药物（DMARDs）不完全应答者的延迟治疗是否对预后不良的极早期类风湿关节炎（RA）患者有效。我们检查了22例抗环瓜氨酸肽抗体或igm -类风湿因子阳性的非常早期RA患者。入组时平均病程14.1周。一种针对简化疾病活动指数（SDAI）缓解的从治疗到目标的策略开始使用合成dmard。22例单独使用合成dmard的患者中有9例未达到SDAI缓解，在这些患者中添加了TNF抑制剂。在接下来的6个月里，我们进一步检查了这9例患者的SDAI值。TNF抑制剂（英夫利昔单抗8，依那西普1）在合成dmard开始后平均间隔34.1周加入。在引入TNF抑制剂后3个月，9例患者中有4例（44.4%）达到了SDAI缓解，9例患者中有8例（88.9%）在引入TNF抑制剂后6个月达到了SDAI缓解。这些患者的影像学损伤未见进展。对于预后因素较差的极早期RA患者延迟使用TNF抑制剂治疗是有效且可耐受的。
We aimed to investigate whether delayed treatment with tumor necrosis factor (TNF) inhibitors in incomplete responders to synthetic disease-modifying anti-rheumatic 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.