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[139] - Repair of Bone Erosions in
Patients Treated with TNF Antagonists in the Real
World.
Kaoru Takase, MD1,Kouji Kobayashi2,Kayo
Terauchi2,Toshiyuki Watanabe2,Reikou
Watanabe2,Maasa Hama2,Rhusuke
Yoshimi2,Hiroshi Kobayashi2,Atsushi
Ihata2,Atsuhisa Ueda2,Mitsuhiro
Takeno2,Haruko Ideguchi3,Shigeru
Ohno3,Yoshiaki Ishigatsubo, MD1.
1Department of Internal Medicine and Clinical
Immunology, Yokohama City University Graduate School of Medicine,
Yokohama,2Department of Internal Medicine and Clinical
Immunology, Yokohama City University Graduate School of
Medicine,3Center for Rheumatic Diseases, Yokohama City
University Medical Center
Objectives: A number of clinical studies have
shown that TNF antagonists suppress not only clinical symptoms but
also the progression of joint destructions in patients with RA.
Moreover, the therapeutic effects are accompanied by repair of bone
erosions in some patients, though the prevalence is uncertain in
the real world. We have previously reported that repair of bone
erosions was found in 10.7% of RA patients treated with nonbiologic
DMARDs. This study investigated the frequency of repair in RA
patients receiving TNF antagonists and characterized clinical
features in the patients.
Methods: Seventy RA patients (63 female, 7 male; age range,
28-76 years) who fulfilled the 1987 ACR classification criteria and
received TNF antagonists for longer than one year were enrolled in
this study. Radiographs of hands and feet were evaluated before the
initiation of the TNF antagonists including infliximab, etanercept,
and adalimumab, and thereafter annually according to the van der
Heijde modified Sharp score. Bone erosion was defined as a discrete
interruption of the cortical surface, based on standard plain film
radiograph criteria. Evaluators assessed the findings without
clinical information and chronological orders of radiographs in the
same patient. The patients who had repair of bone erosion in any
joints were defined as the repaired group, while the others were
into the non-repaired group.
Results: Mean yearly progression of total Sharp score was
0.39 in all subjects. The score was increased in 15, decreased in
7, and unchanged in 48 patients after one year.
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常规医疗环境下TNF拮抗剂对RA骨侵蚀的修复作用
Takase K, et al. ACR 2010. Present
No: 139.
目的：很多临床研究显示TNF拮抗剂不仅能改善RA患者的临床症状，还能抑制关节破坏进展。一些患者在获得疗效的同时，还伴有骨侵蚀的修复，但其发生率在现实医疗环境中幷不确定。我们之前报告了传统DMARDs治疗后，10.7% RA患者出现骨侵蚀的修复。本研究旨在明确接受TNF拮抗剂治疗的RA患者骨修复的发生率，以及这些患者的临床特征。
方法：本研究共纳入70例RA患者，女性63例，男性7例，年龄为28-76岁，均符合1987年ACR分类诊断标准，接受TNF拮抗剂治疗1年以上，包括英夫利昔单抗、依那西普和阿达木单抗。根据van der Heijde修订的Sharp评分标准，在治疗前进行手、足放射学评估，之后每年一次。根据标准平片放射学标准，骨侵蚀定义为骨皮质表面的非连续性中断。阅片者进行盲态评估。在任一关节出现骨侵蚀修复的患者归入修复组，其余患者归入非修复组。
结果：所有患者的总Sharp评分平均年进展为0.39。一年后，15例患者评分上升，7例下降，48例没有变化。
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Therapies in the repair group were as
follows; etanercept + MTX + PSL 2, etanercept + MTX 1, etanercept +
PSL 1, etanercept alone 1, and infliximab + MTX + PSL 1. Three of
them were concurrently treated with MTX. There were no differences
in Stage, Class, and DAS28 before the initiation of TNF
antagonists. The repaired group showed more favorable clinical
responses to TNF antagonist therapy compared with the non-repair
group. Most patients had a good response according to EULAR
criteria. DAS28 was statistically more reduced in the repaired
group than that in non-repaired group during the first one year of
TNF antagonist therapy (P<0.05).
Discussions: The present study showed that repair of bone
erosion is associated with good response to treatment with TNF
antagonists. Well controlled disease activity is a precondition for
structural recovery, irrespective of therapeutic agents.
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修复组的治疗情况如下：依那西普+MTX+PSL 2例，依那西普+MTX 1例，依那西普+PSL 1例，单用依那西普1例，英夫利昔单抗+MTX+PSL 1例。在使用TNF拮抗剂之前，所有患者在病程、病情、DAS28等方面没有差别。与非修复组相比，修复组对TNF拮抗剂的临床反应更好。根据EULAR标准，大部分患者反应良好。在使用TNF拮抗剂的第一年，修复组的DAS28较非修复组下降明显（P<0.05）。
讨论：本研究显示骨侵蚀修复与对TNF拮抗剂反应良好相关。不管使用何种治疗，控制疾病活动度是结构性修复的先决条件。
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