Efficacy of Anti-TNF Agents As Adjunctive Therapy for Knee Synovitis Refractory to Disease-Modifying Antirheumatic Drugs in Patients with Peripheral Spondyloarthritis

Overview

Journal ISRN Rheumatol

Specialty Rheumatology

Date 2013 Jul 11

PMID 23840963

Authors

Grigorios T Sakellariou

Athanasios D Anastasilakis

Ilias Bisbinas

Anastasios Gketsos

Charalampos Berberidis

Affiliations

Soon will be listed here.

Abstract

Our aim was to evaluate the effectiveness of tumour necrosis factor (TNF) inhibitors as add-on therapy for knee synovitis that did not respond to disease-modifying antirheumatic drugs (DMARDs) and other standard treatments in patients with peripheral spondyloarthritis (SpA). We retrospectively studied 27 SpA patients, in whom an anti-TNF agent was added for active peripheral arthritis with knee synovitis refractory to DMARDs and treatment with low-dose oral corticosteroids and/or nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular (IA) corticosteroids. As response of knee synovitis, were considered the absence of swelling, tenderness, and decreased range of movement in the clinical examination, after 4 months of anti-TNF therapy. In twenty-four (88.9%) of the patients there was response of knee synovitis. No statistical differences in gender (P = 0.53), age (P = 0.88), disease subtype (P = 0.22), and pattern of arthritis (P = 0.20) between knee synovitis responders and nonresponders were found. Fourteen patients managed to stop DMARD therapy and six, all of whom were initially on DMARDs combination, to decrease the number of DMARDs to one, maintaining simultaneously the response of knee synovitis. Our results imply a beneficial effect of adjunctive anti-TNF therapy on knee synovitis not responding to DMARDs and other standard treatments in patients with peripheral SpA.

References

Glintborg B, Ostergaard M, Dreyer L, Krogh N, Tarp U, Hansen M . Treatment response, drug survival, and predictors thereof in 764 patients with psoriatic arthritis treated with anti-tumor necrosis factor α therapy: results from the nationwide Danish DANBIO registry. Arthritis Rheum. 2011; 63(2):382-90. DOI: 10.1002/art.30117. View

Kruithof E, De Rycke L, Roth J, Mielants H, Van den Bosch F, De Keyser F . Immunomodulatory effects of etanercept on peripheral joint synovitis in the spondylarthropathies. Arthritis Rheum. 2005; 52(12):3898-909. DOI: 10.1002/art.21426. View

Green M, Marzo-Ortega H, Wakefield R, Astin P, Proudman S, Conaghan P . Predictors of outcome in patients with oligoarthritis: results of a protocol of intraarticular corticosteroids to all clinically active joints. Arthritis Rheum. 2001; 44(5):1177-83. DOI: 10.1002/1529-0131(200105)44:5<1177::AID-ANR201>3.0.CO;2-5. View

Rudwaleit M, Van den Bosch F, Kron M, Kary S, Kupper H . Effectiveness and safety of adalimumab in patients with ankylosing spondylitis or psoriatic arthritis and history of anti-tumor necrosis factor therapy. Arthritis Res Ther. 2010; 12(3):R117. PMC: 2911911. DOI: 10.1186/ar3054. View

Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A . The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991; 34(10):1218-27. DOI: 10.1002/art.1780341003. View

Gladman D, Antoni C, Mease P, Clegg D, Nash P . Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005; 64 Suppl 2:ii14-7. PMC: 1766874. DOI: 10.1136/ard.2004.032482. View

Ash Z, Gaujoux-Viala C, Gossec L, Hensor E, FitzGerald O, Winthrop K . A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis. 2011; 71(3):319-26. DOI: 10.1136/ard.2011.150995. View

Baranauskaite A, Raffayova H, Kungurov N, Kubanova A, Venalis A, Helmle L . Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the RESPOND study. Ann Rheum Dis. 2011; 71(4):541-8. PMC: 3298666. DOI: 10.1136/ard.2011.152223. View

Braun J, van der Horst-Bruinsma I, Huang F, Burgos-Vargas R, Vlahos B, Koenig A . Clinical efficacy and safety of etanercept versus sulfasalazine in patients with ankylosing spondylitis: a randomized, double-blind trial. Arthritis Rheum. 2011; 63(6):1543-51. DOI: 10.1002/art.30223. View

10.

Brandt J, Khariouzov A, Listing J, Haibel H, Sorensen H, Rudwaleit M . Successful short term treatment of patients with severe undifferentiated spondyloarthritis with the anti-tumor necrosis factor-alpha fusion receptor protein etanercept. J Rheumatol. 2004; 31(3):531-8. View

11.

Bond S, Farewell V, Schentag C, Gladman D . Predictors for radiological damage in psoriatic arthritis: results from a single centre. Ann Rheum Dis. 2006; 66(3):370-6. PMC: 1856017. DOI: 10.1136/ard.2006.056457. View

12.

Marzo-Ortega H, Green M, Keenan A, Wakefield R, Proudman S, Emery P . A randomized controlled trial of early intervention with intraarticular corticosteroids followed by sulfasalazine versus conservative treatment in early oligoarthritis. Arthritis Rheum. 2007; 57(1):154-60. DOI: 10.1002/art.22467. View

13.

Van den Bosch F, Kruithof E, Baeten D, Herssens A, De Keyser F, Mielants H . Randomized double-blind comparison of chimeric monoclonal antibody to tumor necrosis factor alpha (infliximab) versus placebo in active spondylarthropathy. Arthritis Rheum. 2002; 46(3):755-65. DOI: 10.1002/art.511. View