Tumor necrosis factor–blocking therapies appear to inhibit the radiographic progression of damage to large, weight-bearing joints in rheumatoid arthritis patients who have low-grade damage scores, and the agents may even reverse damage in certain joints, according to Dr. Isao Matsushita, who reported the findings on June 18 at the annual European Congress of Rheumatology in Rome.

Radiographs in 38 consecutive RA patients that were taken of 232 weight-bearing joints—including 63 hips, 51 knees, 67 ankles, and 51 subtalar joints—showed progression of joint damage in 34 joints (14.7%) at 2 years, and in 37 joints (15.9%) at 3 years in the patients, who were evaluated at baseline and after treatment with infliximab or etanercept.

Repair of joint damage was noted in six ankles and two subtalar joints, noted Dr. Matsushita of the University of Toyama (Japan).

An analysis by baseline damage grade showed that progression was “practically inhibited” by TNF-blocking therapy in patients with a Larsen damage score of 0/I, but that rapid progression occurred despite therapy in hip and knee joints with preexisting grade III/IV damage, Dr. Matsushita explained in interviews.

In most cases, joint damage did not progress in the hips and knees of patients with Larson scores of 0-II. The exception was in patients with highly active RA, in which joint damage occurred over the 3 years of follow up despite a low Larsen score at baseline and TNF blockade, he said.

When disease activity was high at 1 year after therapy was initiated, more than 60% of joints showed the progression of structural damage at 2- and 3-year follow-up.

Joints with ankylosis or a history of surgical intervention were excluded from the study. Structural damage was assessed using both the Larsen scoring method and comparative evaluation of erosions and joint-space narrowing on the radiographs. Radiographic progression was defined as the appearance of new erosion and/or the enlargement of erosions above 2 mm and/or joint space narrowing above 2 mm, he explained.

The findings are important, because although TNF-blocking therapy has been shown to inhibit disease progression in smaller joints of the hands and feet, its effects on large, weight-bearing joints have been unclear until now.

“Damage to weight-bearing joints, such as hip, knee, and ankle joints, is strongly associated with walking disability, and therefore can have adverse effects on activities of daily living in rheumatoid arthritis patients,” Dr. Matsushita said.

The findings of this study suggest that—at least in certain patients with lower grade damage and lower disease activity—TNF inhibitors may be effective for halting and even reversing joint damage, he said.

“It is conceivable that early intervention and tight control by TNF-blocking therapy may be necessary to effectively prevent radiographic progression in weight-bearing joints of rheumatoid arthritis,” he concluded. Dr. Matsushita reported having no disclosures.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

6月18日，在罗马召开的2010年欧洲风湿病学年会上，Isao Matsushita博士报告称，肿瘤坏死因子(TNF)阻滞治疗可抑制类风湿关节炎(RA)患者承重大关节破坏的放射学进展，而且这类药物甚至可能逆转部分关节的破坏。

 

研究者对38例连续RA患者的232个承重关节进行了X线摄片检查，其中包括63个髋关节、51个膝关节、67个踝关节和51个距下关节。结果显示，经英夫利昔单抗或依那西普治疗后，第2年有34个关节(14.7%)的破坏较之基线进展，第3年则有37个关节(15.9%)的破坏较之基线进展。

 

日本富山大学的Matsushita博士指出，检查发现6个踝关节和2个距下关节的破坏得以修复。

 

Matsushita博士在采访中解释道，基线破坏程度分级分析显示，在Larsen破坏评分为0/I级的患者中，TNF阻滞治疗抑制破坏进展的作用“尤其突出”，不过对于之前破坏程度已达到III/IV级的髋关节和膝关节，虽然经过了治疗但仍然出现快速进展。

 

Matsushita博士说，在大部分病例中，只要Larsen评分为0-II级，髋关节和膝关节的破坏一般都没有进展。例外的是，在高度活动的RA患者中，虽然基线Larsen评分较低，且经过了TNF阻滞剂的治疗，但在3年的随访期内还是出现了关节破坏。

 

如果开始治疗后1年疾病活动度仍然较高，那么超过60%的关节都会在随访第2年和第3年出现结构性破坏进展。

 

Matsushita博士解释道，关节强直或既往有手术干预史的患者被排除在该试验之外。试验采用Larsen评分法和X片上关节侵蚀和关节腔狭窄的对比评价对结构性破坏的程度进行评估。放射学进展定义为出现了新的侵蚀灶和(或)原有侵蚀灶扩大2 mm以上和(或)关节腔变窄2 mm以上。

 

鉴于虽然已经证实TNF阻滞治疗可抑制手足小关节的疾病进展，但其对于承重大关节的作用目前尚不清楚，因此这项试验的发现很重要。

 

Matsushita博士说：“诸如髋关节、膝关节和踝关节一类的承重关节破坏与行走残疾明显相关，因此会给类风湿关节炎患者的日常生活活动造成不良影响。”

 

Matsushita博士说，这项试验的发现表明，至少对于部分破坏程度较轻和疾病活动度较低的患者，TNF阻滞剂可有效抑制甚至逆转关节破坏。

 

Matsushita博士总结道：“可想而知，要有效预防类风湿关节炎患者承重关节的放射学进展，可能有必要通过TNF阻滞治疗进行早期干预和严格控制。” Matsushita博士声明无相关利益冲突。

 

爱思唯尔 版权所有