Does Combined Clinical and Ultrasound Assessment Allow Selection of Individuals With Rheumatoid Arthritis for Sustained Reduction of Anti–Tumor Necrosis Factor Therapy?

Arthritis Care and Research - Tập 67 Số 6 - Trang 746-753 - 2015
Jonathan L. Marks1, Christopher Holroyd1, Borislav D. Dimitrov2, Ray Armstrong1, Antonia Calogeras1, Cyrus Cooper3, Brian Davidson1, Elaine Dennison4, Nicholas C. Harvey5, Christopher J Edwards6
1University Hospital Southampton, Southampton, UK
2University of Southampton, Southampton, UK
3University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, and University of Oxford, Oxford, UK.
4University Hospital Southampton and University of Southampton, Southampton, UK
5University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
6University of Southampton and University Hospital Southampton, Southampton, UK, and University of Oxford, Oxford, UK

Tóm tắt

ObjectiveTo investigate whether a strategy combining clinical and ultrasound (US) assessment can select individuals with rheumatoid arthritis (RA) for sustained dose reduction of anti–tumor necrosis factor (anti‐TNF) therapies.MethodsAs part of a real‐world approach, patients with RA receiving anti‐TNF therapies were reviewed in a dedicated biologic therapy clinic. Patients not taking oral corticosteroids with both Disease Activity Score in 28 joints (DAS28) remission (≤2.6) and absent synovitis on power Doppler US (PDUS 0) for >6 months were invited to reduce their anti‐TNF therapy dose by one‐third.ResultsBetween January 2012 and February 2014, a total of 70 patients underwent anti‐TNF dose reduction. Combined DAS28 and PDUS remission was maintained by 96% of patients at 3 months followup, 63% at 6 months, 37% at 9 months, and 34% at 18 months followup. However, 88% of patients maintained at least low disease activity (LDA) with DAS28 <3.2 and PDUS ≤1 at 6 months. The addition of PDUS identified 8 patients (25% of those that flared) in DAS28 remission, with subclinically active disease. Those who maintained dose reduction were more likely to be rheumatoid factor (RF) negative (46% versus 17%; P = 0.03) and have lower DAS28 scores at biologic therapy initiation (5.58 versus 5.96; P = 0.038).ConclusionCombined clinical and US assessment identifies individuals in remission who may be suitable for anti‐TNF dose reduction and enhances safe monitoring for subclinical disease flares. Despite longstanding severe RA, a subset of our cohort sustained prolonged DAS28 and PDUS remission. LDA at biologic therapy initiation and RF status appeared predictive of sustained remission.

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Arthritis Care and Research

Tập 67 Số 6

746-753

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