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

Modern Rheumatology, 09/13/2011

Kita J et al. – Delayed treatment with tumor necrosis factor (TNF) inhibitors is effective and tolerable for patients with very early rheumatoid arthritis (RA) with poor prognosis factors.

Methods

  • The authors 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.

Results

  • 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.

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