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.