Abstract
The aim of this study was to investigate remission and biologic-free remission after orthopaedic surgery and related clinical factors in non-responder to infliximab for rheumatoid arthritis (RA). We analyzed 74 patients who were treated with 3 mg/kg infliximab and methotrexate and underwent orthopaedic surgery after non-responder to infliximab with disease activity score (DAS) 28 (CRP) of ≥3.2. The rates of remission and biologic-free remission at 52 weeks after orthopaedic surgery were investigated and the clinical factors related to remission and biologic-free remission were analyzed by logistic regression and receiver-operating characteristic analyses. The rates of total remission and biologic-free remission were 37/74 (50 %) and 9/74 (12.2 %), respectively. Regarding orthopaedic surgery, the rates of remission and biologic-free remission were 25/38 (65.8 %) and 7/38 (18.4 %) for synovectomy, 7/20 (35 %) and 0/20 (0 %) for arthroplasty, and 5/16 (31.3 %) and 2/16 12.5) for others including spine surgery and foot surgery. DAS28(CRP) at baseline was significantly related to both remission and biologic-free remission. Prednisolone was negatively associated with remission, and DAS28(CRP) was related to biologic-free remission by logistic regression analyses. DAS28(CRP) below 3.7 was cutoff point for acquiring biologic-free remission of non-responder to infliximab after orthopaedic surgery. Therefore orthopaedic surgery may be effective to obtain remission or biologic-free remission in RA patients treated with biologics.
Highlights
Anti-tumor necrosis factor (TNF)-α therapy such as infliximab for rheumatoid arthritis (RA) is used to inhibit inflammation, and to suppress bone and joint destruction
It is reported that infliximab leads biologicfree remission in the long term for early RA patients with good responses
The infliximab treatment included a diagnosis of RA based on the American College of Rheumatology (ACR) criteria (Arnett et al 1988), and categorization according to Steinbrocker et al (Steinbrocker et al 1949)
Summary
Anti-tumor necrosis factor (TNF)-α therapy such as infliximab for rheumatoid arthritis (RA) is used to inhibit inflammation, and to suppress bone and joint destruction. It is reported that infliximab leads biologicfree remission in the long term for early RA patients with good responses (van der Kooij et al 2009; Bejarano et al 2010; Quinn et al 2005; van der Bijl et al 2007; van den Broek et al 2011). It is difficult to induce biologic-free remission in non-responder to infliximab. No reports to date have described how orthopaedic surgery contributes to remission or biologic-free remission. AntiTNF-α therapy cannot improve the clinical outcomes in some patients with joint swelling and tenderness with.
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