Efficacy of Anti-TNF Agents as Adjunctive Therapy for Knee Synovitis Refractory to Disease-Modifying Antirheumatic Drugs in Patients with Peripheral Spondyloarthritis
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 ( ), age ( ), disease subtype ( ), and pattern of arthritis ( ) 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. 1. Introduction Diseases that belong to spondyloarthritides (SpA) are frequently manifested as asymmetric peripheral arthritis of the large joints with knee involvement. Tumour necrosis factor (TNF) inhibitors are highly effective for the treatment of peripheral arthritis in patients with ankylosing spondylitis (AS) [1, 2], psoriatic arthritis (PsA) [3], undifferentiated SpA (unSpA) [4], or SpA as a whole independently of the phenotypic disease [5], even in the case of arthritis resistant to disease-modifying antirheumatic drugs (DMARDs). However, data on the effect of anti-TNF therapy specifically on knee synovitis are limited in peripheral SpA [6]. The aim of this retrospective study was to evaluate the effectiveness of anti-TNF agents as adjunctive therapy for knee synovitis that did not respond to DMARDs and other standard treatments in patients with peripheral SpA. 2. Patients and Methods We retrospectively studied patients with SpA according to the European SpA Study Group criteria [7] and peripheral arthritis involving the knee joint, who were monitored every 2–4 months at the rheumatology outpatient clinic of the 424 General Military Hospital (Thessaloniki, Greece) between January 2005 and
References
[1]
M. Rudwaleit, F. Van den Bosch, M. Kron, S. Kary, and H. Kupper, “Effectiveness and safety of adalimumab in patients with ankylosing spondylitis or psoriatic arthritis and history of anti-tumor necrosis factor therapy,” Arthritis Research and Therapy, vol. 12, no. 3, article R117, 2010.
[2]
J. Braun, I. E. Van Der Horst-Bruinsma, F. Huang et al., “Clinical efficacy and safety of etanercept versus sulfasalazine in patients with ankylosing spondylitis: a randomized, double-blind trial,” Arthritis and Rheumatism, vol. 63, no. 6, pp. 1543–1551, 2011.
[3]
Z. Ash, C. Gaujoux-Viala, L. Gossec et al., “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,” Annals of the Rheumatic Diseases, vol. 71, no. 3, pp. 319–326, 2012.
[4]
J. Brandt, A. Khariouzov, J. Listing et al., “Successful short term treatment of patients with severe undifferentiated spondyloarthritis with the anti-tumor necrosis factor-α fusion receptor protein etanercept,” Journal of Rheumatology, vol. 31, no. 3, pp. 531–538, 2004.
[5]
F. Van Den Bosch, E. Kruithof, D. Baeten et al., “Randomized double-blind comparison of chimeric monoclonal antibody to tumor necrosis factor α (infliximab) versus placebo in active spondylarthropathy,” Arthritis and Rheumatism, vol. 46, no. 3, pp. 755–765, 2002.
[6]
E. Kruithof, L. De Rycke, J. Roth et al., “Immunomodulatory effects of etanercept on peripheral joint synovitis in the spondylarthropathies,” Arthritis and Rheumatism, vol. 52, no. 12, pp. 3898–3909, 2005.
[7]
M. Dougados, S. Van der Linden, R. Juhlin et al., “The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy,” Arthritis and Rheumatism, vol. 34, no. 10, pp. 1218–1227, 1991.
[8]
A. Baranauskaite, H. Raffayová, N. V. Kungurov et al., “Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: The RESPOND Study,” Annals of the Rheumatic Diseases, vol. 71, pp. 541–548, 2012.
[9]
B. Glintborg, M. ？stergaard, L. Dreyer et al., “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 and Rheumatism, vol. 63, no. 2, pp. 382–390, 2011.
[10]
D. D. Gladman, C. Antoni, P. Mease, D. O. Clegg, and O. Nash, “Psoriatic arthritis: epidemiology, clinical features, course, and outcome,” Annals of the Rheumatic Diseases, vol. 64, no. 2, pp. ii14–ii17, 2005.
[11]
S. J. Bond, V. T. Farewell, C. T. Schentag, and D. D. Gladman, “Predictors for radiological damage in psoriatic arthritis: results from a single centre,” Annals of the Rheumatic Diseases, vol. 66, no. 3, pp. 370–376, 2007.
[12]
H. Marzo-Ortega, M. J. Green, A.-M. Keenan, R. J. Wakefield, S. Proudman, and P. Emery, “A randomized controlled trial of early intervention with intraarticular corticosteroids followed by sulfasalazine versus conservative treatment in early oligoarthritis,” Arthritis Care and Research, vol. 57, no. 1, pp. 154–160, 2007.
[13]
M. Green, H. Marzo-Ortega, R. J. Wakefield, et al., “Predictors of outcome in patients with oligoarthritis: results of a protocol of intraarticular corticosteroids to all clinically active joints,” Arthritis & Rheumatism, vol. 44, pp. 1177–1183, 2001.
