Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Radiographic Progression of Cervical Lesions in Patients with Rheumatoid Arthritis Receiving Infliximab Treatment
Kanayama, Yasuhide, Kojima, Toshihisa, Shioura, Tomone, Hayashi, Masatoshi, Funahashi, Koji, Ishiguro, Naoki
Cervical lesions are known to occur at high frequency as a complication of rheumatoid arthritis (RA). Treatment with Anti-TNFa agents are more clinically effective than the disease-modifying antirheumatic drugs (DMARDs) that were in use previously, in particular, with their efficacy in suppressing joint destruction having been emphasized. However, most clinical studies on the efficacy of biological agents in suppressing joint destruction in the hands and feet, and no studies have been carried out on efficacy against cervical lesions. Therefore, we carried out the present study, which was a prospective investigation in patients receiving infliximab, in order to elucidate the efficacy of infliximab for inhibiting the radiographic progression of RA cervical lesions.
This study was carried out with 47 patients with active RA who received continuous infliximab treatment for at least 1 year. Infliximab treatment was initiated between November 2003 and December 2007. The infliximab dose was 3 mg/kg. The first three doses were administered at Week 0, 2 and 6, and the fourth and later doses were administered every 8 weeks up to Week 54. For evaluation of cervical lesions, the atlanto-dental interval (ADI), the space available for the spinal cord (SAC), and the Ranawat value were measured by plain lateral radiographs in the flexion position, at baseline and Week 54.
When progression was defined as a change of 1 mm or more in one of the radiographic cervical lesion parameters for a period of 1 year, the numbers of patients, of a total of 47, who showed progression in ADI, SAC and Ranewat value were 16 (34%), 15 (32%), and 10 (21%), respectively, and the number who showed progression in at least one of these three parameters was 20 (43%).With respect to MMP3, the non-progressive group showed marked and significant alleviation in 1 year, from 423.6 ± 389.4 to 165.5 ± 150.8 ng/ml (p < 0.001), whereas the change in the progressive group was from 305.2 ± 222.7 to 224.4 ± 109.5 ng/ml (p = 0.136), which was not significant. At Week 54, the responses to infliximab on the basis of the EULAR response criteria were good and moderate in 23 patients (49%) and 24 patients (51%), respectively. Whereas cervical lesion progression was suppressed in 19 of 23 good-response patients (83%), progression occurred in 16 of 24 moderate-response patients (67%), and this difference was shown to be significant by the Fisher's exact test (p = 0.002). In the good-response patients (n = 23) and moderate-response patients (n = 24), the respective changes in cervical lesion parameters in 1 year were as follows: ADI: 0.17 ± 0.49 and 0.54 ± 0.58 mm (p = 0.013); SAC: -0.17 ± 0.49 and -0.54 ± 0.59 mm (p = 0.025); and Ranawat value: -0.09 ± 0.29 and -0.42 ± 0.65 mm (p = 0.032).
Infliximab treatment can be used to suppress the progression of RA cervical lesions, as well as hand and foot joints lesions. It is possible that response to infliximab and MMP3 improvement could be used to predict the progression of RA cervical lesions.
To cite this abstract, please use the following information:
Kanayama, Yasuhide, Kojima, Toshihisa, Shioura, Tomone, Hayashi, Masatoshi, Funahashi, Koji, Ishiguro, Naoki; Radiographic Progression of Cervical Lesions in Patients with Rheumatoid Arthritis Receiving Infliximab Treatment [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1677