Abstract
BackgroundRheumatoid arthritis (RA) is a chronic autoinflammatory joint disease which leads to the destruction of joints and disability of the patients. Anti-tumour necrosis factor (anti-TNF) drugs can halt radiological progression better than conventional DMARDs even in clinical non-responders.MethodsThe efficacy of anti-TNF plus methotrexate (MTX) treatment versus MTX monotherapy on clinical and radiological outcomes were compared in early rheumatoid arthritis (RA) patients in clinical practice by retrospective analysis of an observational cohort.49 early RA patients (group A) on first-line MTX monotherapy and 35 early RA patients (group B) on anti-TNF plus MTX treatment were selected from an observational cohort and evaluated retrospectively focusing on their first twelve months of treatment. Data on disease activity (DAS28) and functional status (HAQ-DI) were collected three monthly. One-yearly radiological progression was calculated according to the van der Heijde modified Sharp method (vdHS). Clinical non-responder patients in both groups were selectively investigated from a radiological point of view.ResultsDisease activity was decreased and functional status was improved significantly in both groups. One-yearly radiological progression was significantly lower in group B than in group A. The percentage of patients showing radiological non-progression or rapid radiological progression demonstrated a significant advantage for group B patients. In addition non-responder patients in group B showed similar radiological results as responders, while a similar phenomenon was not observed in patients in group A.ConclusionsClinical efficacy within our study was similar for tight-controlled MTX monotherapy as well as for combination treatment with anti-TNF and MTX. However MTX monotherapy was accompanied by more rapid radiological progression and less radiological non-progression. Anti-TNF plus MTX decreased radiological progression even in clinical non-responders supporting the advantage of anti-TNF plus MTX combination in dissociating clinical and radiological effects.
Highlights
Rheumatoid arthritis (RA) is a chronic autoinflammatory joint disease which leads to the destruction of joints and disability of the patients
Biological agents have proven to be effective in patients responding insufficiently to MTX in randomised controlled trials (RCTs), in reducing disease activity and improving functional status, but in slowing radiological progression [9,10,11,12,13,14,15]
Monoclonal antibodies against TNF including adalimumab, etanercept and infliximab, and lately the interleukin-6 receptor inhibitor tocilizumab and anti-CD20 rituximab prevented joint destruction even in patients failing to show a clinical response to MTX monotherapy [16,17,18,19,20]
Summary
Rheumatoid arthritis (RA) is a chronic autoinflammatory joint disease which leads to the destruction of joints and disability of the patients. Monoclonal antibodies against TNF including adalimumab, etanercept and infliximab, and lately the interleukin-6 receptor inhibitor tocilizumab and anti-CD20 rituximab prevented joint destruction even in patients failing to show a clinical response to MTX monotherapy [16,17,18,19,20]. Such “dissociation” between disease activity and radiological progression appears to be an additional advantage of biologics
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