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, 09/14/2011
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.
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.
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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