Outcome of patients with seronegative spondyloarthritis continuing sulphasalazine and methotrexate after a short course of infliximab therapy—experience from a tertiary care teaching hospital in South India

Abstract

The objective of the study is to evaluate the outcome of patients with seronegative spondyloarthritis continuing on sulphasalazine (SSZ) and methotrexate (MTX) after a short course of infliximab. Patients with seronegative spondyloarthritis on MTX and SSZ were given short course of infliximab therapy at 0, 2, 6 and 14weeks. Outcome of these patients while continuing on MTX and SSZ was assessed. Clinical features, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were noted at baseline (pre-infliximab), 1month, 3months and last follow-up after last dose of infliximab infusion. Twenty-four patients were included in this study. The mean duration of follow-up was 9.1months. Statistically significant reduction in tender and swollen joint count was noted at all the three visits as compared to baseline. Fall in ESR and CRP was statistically significant at 1 and 3months, but not at last follow-up. Mean reduction in BASDAI at 1month ,3month and last follow-up after last infliximab dose were 3.907 (95% CI 2.98-4.83; p < 0.001), 4.53 (95% CI 3.56-5.49; p < 0.001) and 2.48 (95% CI 1.12-3.84; p = 0.002), respectively. Mean reduction in BASFI at 1month, 3months and last follow-up after last infliximab dose were 4.13 (95% CI 3.23-5.04; p < 0.001), 4.34 (95% CI 2.8-5.88; p < 0.001) and 2.38 (95% CI 0.86-3.90; p = 0.005), respectively. Continuing SSZ and MTX after short course of infliximab results in sustained improvement in our patients with seronegative spondyloarthritis in India.