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Rheumatoid Arthritis
therapy. In that case, the use of a second or even third anti-TNF agent
is an extended practice but the possibility of achieving significant rates
Early, aggressive treatment of
in DAS and HAQ responses is more limited.
31,33
It is likely that better
responses can be expected if the reason for switching is an adverse
rheumatoid arthrititis with definite
event, and not inefficacy, to the first anti-TNF.
34,35
New agents
goals, including physical-function
targeting CD20 B-cell surface receptor, rituximab or CD80/86
co-stimulation molecules on T cells, have been assayed in patients
improvement and radiographic
with anti-TNF failure. Both drugs have demonstrated efficacy,
outcome, with a parallel reduction of
significantly decreasing disease activity and improving physical
function in these patients.
18,20,36
disease activity, is mandatory.
In summary, although the HAQ is not a perfect gold standard for
measuring the physical function of RA patients, it is an easy, reliable
of anti-TNF drugs improves the HAQ score from 1.6 to 1.1, which is far and feasible questionnaire, with high performance in several settings
more than what is considered as a clinically important response (the (clinical practice and trials) and different countries. The improvement
cut point is 0.2). This parallels a significant decrease of disease activity in the HAQ is early and sustained, after the start of DMARDs or
measured by Disease Activity Score (DAS).
31
Several clinical trials have biological therapy. Early, aggressive treatment of RA with definite
proved that using anti-TNF drugs early in RA is more efficacious than goals, including physical-function improvement and radiographic
methotrexate alone or a sequential treatment escalation.
32
outcome, with a parallel reduction of disease activity, is mandatory.
This strategy, optimising the different treatments and focusing on
Early anti-TNF therapy is an increasing practice in patients with severe individual patients, will result in more beneficial management of this
disease. Unfortunately, many patients fail to respond to anti-TNF complex disease. ■
1. Larsen A, Dale K, Eek M, Radiographic evaluation of 15. Keystone E, Kavanaugh A, Sharp J, et al., Radiographic, clinical term impact of early treatment on radiographic progression in
rheumatoid arthritis and related conditions by standard and functional outcomes of treatment with adalimumab (a rheumatoid arthritis: a meta-analysis, Arthritis Rheum,
reference films, Acta Radiol Diagn, 1977;18:481–90. Human Anti-Tumour necrosis factor monoclonal antibody) in 2006;55:864–72.
2. Sharp JT, et al., Methods of scoring the progression of patients with active rheumatoid arthritis receiving concomitant 26. Fries JF, Spitz PW, Kraines RG, et al., Measurements of patient
radiologic changes in rheumatoid arthritis, Arthritis Rheum, methotrexate therapy, Arthritis Rheum, 2004;50:1400–11. outcome in arthritis, Arthitis Rheum, 1980;23:137–45.
1971;14:706–20. 16. Klareslog L, van der Heijde D, de Jager J, et al., Therapeutic 27. Plant MJ, O’Sullivan MM, Lewis PA, et al., What factors
3. Lassere M, Boers M, van der Heijde D, et al., Smallest effect of the combination of etanercept and methotrexate influence functional ability in patients with rheumatoid arthritis.
detectable difference in radiological progression, J Rheumatol, compared with each treatment alone in patients with Do they alter over time?, Rheumatology, 2005;44:1181–5.
1999 Mar;26(3):731–9. rheumatoid arthritis: double-blind randomised controlled trial, 28. Aletahla D, Smollen J, Ward MM, Measuring function in
4. van der Hejide D, Boers M, Lassere M, Methodological Issues Lancet, 2004;363:675–81. rheumatoid arthritis: Identifying reversible and irreversible
in Radiographic Scoring Methods in RA OMERACT IV, 17. Lipsky PE, van der Hejide D, St Clair EW, et al., Infliximab and components, Arthritis Rheum, 2006;54:2784–92.
J Rheumatol, 1999 Mar;26(3);717. methotrexate in the treatment of rheumatoid arthritis, N Engl J 29. Stand V, Long term benefits of treating rheumatoid arthritis:
5. Emery P, The optimal management of early rheumatoid Med, 2000;343:1594–602. assessment of radiographic damage and physical function in
arthritis: the key to preventing disability, Br J Rheumatol, 18. Kremer JM; Genant HK, Moreland LW, et al., Effects of clinical trials, Clin Exp Rheumatol, 2004;(Suppl 35):S57–64.
1994;33:765–8. abatacept in patients with methotrexate-resistant active 30. Mfttfen T, Hannonen P, Leisiralo-Repo M, et al., Comparison of
6. van der Heijde D, Radiographyc progression in rheumatoid rheumatoid arthritis: a randomized trial, Ann Intern Med, combination therapy with single drug therapy in early
arthritis: Does it reflect outcome? Does it reflect treatment?, 2006;144:865–76. rheumatoid arthritis: a randomized trial. FIN-RACO trial group,
Ann Rheum Dis, 2001;60:iii47–iii50. 19. Bresnihan B, Cobby M, Clinical and radiological effects of Lancet, 1999;353:1568–73.
7. Scott D, Pugner K, Kaarela K, et al., The links between joint anakinra in patients with rheumatoid arthritis, Rheumatology, 31. Federico Navarro, Juan J, Gómez-Reino, et al., Physical function
damage and disability in rheumatoid arthritis, Rheumatology, 2003;42 Suppl 2:ii22–8. (HAQ) response in clinical practice in RA patients after
2000;39:122–32. 20. Cohen SB, Emery P, Greenwald MW, et al., Rituximab for switching to a second or a third anti-TNF agent: results of an
8. Finckh A, Liang M, Mugica C, et al., Long-term impact of early rheumatoid arthritis refractory to anti-tumour necrosis factor observational, prospective, cohort study in Spain, Arthritis
treatment on radiographic progression in rheumatoid arthritis, therapy: Results of a multicenter, randomized, double-blind, Rheum, 2006;54(Suppl.):S383.
Arthritis Rheum, 2006;55:864–72. placebo-controlled, phase III trial evaluating primary efficacy 32. de Vries-Bouwstra JK, Dijkmans BAC, Breedveld FC, Biologic
9. Iannuzzi L, Dawson N, Zein N, et al., Does drug therapy slow and safety at twenty-four weeks, Arthritis Rheum, 2006;54: agents in early rheumatoid arthritis, Rheum Dis Clin North Am,
radiographic deterioration in rheumatoid arthritis?, N Engl J 2793–806. 2005;7:631–45.
Med, 1983;309:1023–8. 21. Emery P, Fleischmann R, Filipowicz-Sosnowska A, et al., The 33. Solau-Gervais E, Laxenaire N, Cortet B, et al., Lack of efficacy
10. Jones G, Halbert J, Crotty M, et al., The effect of treatment on efficacy and safety of rituximab in patients with active of a tumor necrosis factor alpha antagonist alter failure of a
radiological progression in rheumatoid arthritis: a systematic rheumatoid arthritis despite methotrexate treatment: results of soluble receptor and a monoclonal antibody, Rheumatology,
review of randomized placebo-controlled trials, Rheumatology, a phase IIB randomized, double-blind, placebo-controlled, dose- 2006;45:1121–4.
2003;42:6–13. ranging trial, Arthritis Rheum, 2006;54:1390–400. 34. Hyrich KL, Lunt M, Watson KD, et al., Outcomes after switching
11. Boers M, Verhoeven AC, Markusse HM, et al., Randomised 22. Smolen JS, Han C, Bala M, et al., Evidence of radiographic from one anti-tumor necrosis factor-α agent to a second anti-
comparison of combined step-down prednisolone, methotrexate Benefit of treatment with infliximab plus methotrexate in tumor necrosis factor-α agent in patients with rheumatoid
and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis patients who had no clinical improvement: arthritis: Results from a large UK national cohort study, Arthritis
rheumatoid arthritis, Lancet, 1997;350:309–18. a detailed sub-analysis of data of the Anti-tumour necrosis Rheum, 2006;56:13–20.
12. Luukkainen R, Sokka T, Kautiainen H, et al, FIN-RACo Trial factor trial in rheumatoid arthritis, Arthritis Rheum, 2005;52: 35. Gomez-Reino JJ, Carmona L, BIOBADASER group, Switching
Group. Prognosis of 5-year radiographic erosions of the wrist 1020–30. TNF antagonists in patients with chronic arthritis: an
according to early, late, and persistent wrist swelling or 23. Boers M, for the COBRA study, Demonstration of response in observational study of 488 patients over a four-year period,
tenderness in patients with early rheumatoid arthritis, rheumatoid arthritis patients who are no responders according Arthritis Res Ther, 2006;8:R29.
J Rheumatol, 2007;34:50–53. to the American College of Rheumatologist 20% criteria: the 36. Hammond T, Navarro F, Gómez-Reino JJ, et al., Treatment with
13. Gartleher G, Nansen RA, Jonas BL, et al., The comparative paradox of beneficial treatment effects in no responders in the Abatacept improves physical function and health related quality
efficacy and safety of biologics for the treatment of RA: a ATTRACT trial, Arthritis Rheum, 2001;44:2703–4. of life in rheumatoid arthritis patients with inadequate response
systematic review and meta analysis, J Rheumatol, 2006;33: 24. Landewe R, van der Heijde D, Klareslog L, et al., Disconnect to methotrexate and TNF antagonists, Reumatol Clin,
2398–408. between inflammation and joint destruction alter treatment 2006;2:29.
14. Finckh A, Simard J, Duryea J, The effectiveness of Anti-tumour with etanercept plus methotrexate. Results from the trial of
necrosis factor therapy in preventing progressive radiographic etanercept and methotrexate with radiographic and patient
joint damage in rheumatoid arthritis: a population based study, outcomes, Arthritis Rheum, 2006;54:3119–25.
Arthritis Rheum, 2006;54:54–9. 25. Finckh A, Liang M, Mugica van Herckenrode C, et al., Long-
18 EUROPEAN MUSCULOSKELETAL REVIEW 2007
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