TNF抑制剂在10例新近起病的难治性反应性关节炎患者中的安全性与疗效

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Safety and efficacy of anti-TNF alpha therapy in ten patients with recent-onset refractory reactive arthritis† 1.       Alain Meyer1, 2.       Emmanuel Chatelus1, 3.       Daniel Wendling2, 4.       Jean-Marie Berthelot3, 5.       Emmanuelle Dernis4, 6.       Eric Houvenagel5, 7.       Jacques Morel6, 8.       Olivier Richer7, 9.       Thierry Schaeverbeke8, 10.   Jacques-Eric Gottenberg1, 11.   Jean Sibilia1,*,‡, 12.   on behalf of the CRI (Club Rhumatisme et Inflammation)1 DOI: 10.1002/art.30272 Abstract Objective. There are few treatments for reactive arthritis (ReA). Since concentrations of TNF alpha are high in the serum and joints of patients with persistent ReA, this cytokine could be targeted in patients who do not respond to NSAIDs and DMARDs. We therefore investigated the safety and efficacy of TNF antagonists in patients with recent-onset and refractory ReA. Patients and methods. All French rheumatology and internal medicine practitioners registered on the Club Rhumatismes et Inflammation web site were asked to report patients with ReA (criteria of the Third International Workshop on Reactive Arthritis) who had been treated with anti-TNF therapy within the 12 months following the triggering infection. Tolerance and efficacy were retrospectively assessed using a standardized questionnaire. Results. Ten patients suffering of ReA with clinical and microbiological evidence of a triggering bacterial infection, previously refractory to NSAIDs and DMARDs, were treated with anti TNF therapy within a median delay of 6 months [2-12] between the beginning of ReA and the initiation of the treatment. Median follow-up was 20.6 months [6-50]. No severe adverse event and no infection related to the bacterium that triggered the ReA were observed. Anti-TNF therapy was rapidly effective in 9 patients (90%), as shown by the rapid effect on visual analogue pain scale, tender joint count, swollen joint count, extra-articular manifestations, and by the corticosteroid sparing effect. Conclusion: Anti-TNF therapy appears to be a safe and effective treatment for rheumatic and extra-articular manifestations in recent-onset and refractory ReA, with a corticosteroid sparing effect. Thus TNF alpha could be a relevant target for ReA therapy.

TNF抑制剂在10例新近起病的难治性反应性关节炎患者中的安全性与疗效 Alain Meyer,et al.Arthritis & Rheumatism DOI: 10.1002/art.30272   目的：反应性关节炎（ReA）治疗方法甚少。由于TNFα在持续性ReA患者的血清和关节中浓度较高，因此该细胞因子可能可以作为NSAIDs和DMARDs治疗效果欠佳患者的治疗靶点。本文观察了TNF拮抗剂在新近起病的难治性ReA患者中的安全性和疗效。   患者与方法：在Club Rhumatismes et Inflammation网站注册的所有法国风湿科医生和内科医生报告在12个月内使用TNF抑制剂治疗的ReA患者。采用标准化问卷回顾性评估耐受性和疗效。   结果：对NSAIDs和DMARDs疗效欠佳的10例ReA患者使用TNF抑制剂治疗，出现ReA至开始治疗平均延误6个月（2-12）。平均随访20.6个月（6-50）。没有观察到严重不良事件和诱发ReA的细菌感染。9例（90%）患者快速起效，表现为视觉模拟疼痛量表、压痛关节数、肿胀关节数、关节外表现的快速好转和类糖皮质激素效应。   结论：TNF抑制剂治疗新近起病的难治性ReA的关节及关节外症状安全、有效，有类糖皮质激素效应。因此TNFα可作为ReA的治疗靶点。