title: 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.
abstract: We aimed to investigate whether delayed treatment with tumor necrosis factor (TNF) inhibitors in incomplete responders to synthetic disease-modifying anti-rheumatic drugs (DMARDs) was effective among patients with very early rheumatoid arthritis (RA) with poor prognosis factors. We 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. Delayed treatment with TNF inhibitors is effective and tolerable for patients with very early RA with poor prognosis factors.
authors: Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors: Junko
authors: J
authors: Kita
authors: Mami
authors: M
authors: Tamai
authors: Kazuhiko
authors: K
authors: Arima
authors: Yoshikazu
authors: Y
authors: Nakashima
authors: Takahisa
authors: T
authors: Suzuki
authors: Shin-ya
authors: SY
authors: Kawashiri
authors: Akitomo
authors: A
authors: Okada
authors: Tomohiro
authors: T
authors: Koga
authors: Satoshi
authors: S
authors: Yamasaki
authors: Hideki
authors: H
authors: Nakamura
authors: Tomoki
authors: T
authors: Origuchi
authors: Toshiyuki
authors: T
authors: Aramaki
authors: Munetoshi
authors: M
authors: Nakashima
authors: Keita
authors: K
authors: Fujikawa
authors: Toshiaki
authors: T
authors: Tsukada
authors: Hiroaki
authors: H
authors: Ida
authors: Kiyoshi
authors: K
authors: Aoyagi
authors: Masataka
authors: M
authors: Uetani
authors: Katsumi
authors: K
authors: Eguchi
authors: Atsushi
authors: A
authors: Kawakami
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001323:Autoantibodies / Q000097:blood; D042241:Early Diagnosis; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007075:Immunoglobulin M / Q000276:immunology; D000069285:Infliximab; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D020127:Recovery of Function; D012074:Remission Induction; D012217:Rheumatoid Factor / Q000097:blood; D013585:Synovitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D001323:Autoantibodies; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D010456:Peptides, Cyclic; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor; D000069285:Infliximab; D000068800:Etanercept