Abstract
Background. Rheumatoid arthritis is a systemic autoimmune disease characterized by joint erosions, progressive focal bone loss, and chronic inflammation. Methods. 20 female patients with moderate-to-severe rheumatoid arthritis were treated with anti-TNF-antibody adalimumab in addition to concomitant antirheumatic therapies. Patients were assessed for overall disease activity using the DAS28 score, and neopterin, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) concentrations as well as osteoprotegerin (OPG) and soluble receptor activator of NF-κB ligand (sRANKL) concentrations were determined before therapy and at week 12. Neopterin as well as OPG and sRANKL were determined by commercial ELISAs. Results. Before anti-TNF therapy patients presented with high disease activity and elevated concentrations of circulating inflammatory markers. OPG concentrations correlated with neopterin (rs = 0.494, p = 0.027), but not with DAS28. OPG concentrations and disease activity scores declined during anti-TNF-treatment (both p < 0.02). Patients who achieved remission (n = 7) or showed a good response according to EULAR criteria (n = 13) presented with initially higher baseline OPG levels, which subsequently decreased significantly during treatment (p = 0.018 for remission, p = 0.011 for good response). Conclusions. Adalimumab therapy was effective in modifying disease activity and reducing proinflammatory and bone remodelling cascades.
Highlights
Rheumatoid arthritis (RA) is a chronic disease characterized by systemic inflammation and progressive periarticular bone loss leading to joint-related disability
T-and B-lymphocytes, dendritic cells, and other immunocompetent cells are present in the synovia of patients with RA [1], and these cells are involved in the destruction of bone and cartilage as they produce proinflammatory cytokines like tumor necrosis factor-α (TNFα), interleukin-1 (IL-1), interleukin-6 (IL-6), and interferonγ (IFN-γ) [2,3,4]
Most patients suffered from tender and swollen joints and had a moderate-to-high disease activity with a median disease activity score (DAS28) of 5.7 before adalimumab therapy
Summary
Rheumatoid arthritis (RA) is a chronic disease characterized by systemic inflammation and progressive periarticular bone loss leading to joint-related disability. Elevated concentrations of proinflammatory cytokines have been detected in the joints [2,3,4,5] and in the peripheral blood of patients [6,7,8] These cytokines do enhance inflammatory cascades in RA, and target and affect bone metabolism. This is achieved by their influence on the expression of key regulatory proteins such as osteoprotegerin (OPG), receptor activator of NF-κB ligand (RANKL), and soluble RANKL (sRANKL) [3, 9]. Before anti-TNF therapy patients presented with high disease activity and elevated concentrations of circulating inflammatory markers. Adalimumab therapy was effective in modifying disease activity and reducing proinflammatory and bone remodelling cascades
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