Conventional disease modifying anti-rheumatic drugs or biological therapy in rheumatoid arthritis?
Authors:   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Baltă Mihaela Daniela ,   Policlinica Vitan, Bucureşti, Matei Dumitru ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti,   Institutul pentru Ocrotirea Mamei şi Copilului „Alfred Rusescu“, Bucureşti, Milicescu Mihaela ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti,   Clinica de Medicină Internă şi Reumatologie, Spitalul Clinic „I. Cantacuzino“, Bucureşti, Bojincă Mihai ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti,   Clinica de Medicină Internă şi Reumatologie, Spitalul Clinic „I. Cantacuzino“, Bucureşti
Published: September 2021

Objectives. The purpose of this study is the evaluation of a group of patients suffering from rheumatoid arthritis depending on the administered treatment, classical remissive therapy or biological therapy. Materials and methods. We have performed a retrospective study on a group of 214 patients diagnosed with rheumatoid arthitis, admitted in the Internal Medicine and Rheumatology Clinic of „Dr. I. Cantacuzino“ Clinical Hospital Bucharest, 92 of whom were being administered biological therapy (etanercept, infliximab, adalimumab or rituximab) along with classical remissive therapies (methotrexate, leflunomide, sulfasalazine), and 122 of whom were only being administered classical treatment. We have studied and supervised the influence of these therapies on disease evolution, together with paying attention to several other health risks present in rheumatoid arthritis patients (cardiovascular risk, osteoporosis, joint replacement surgery, neoplasms). Results. In the studied group, the seropositive disease forms predominated (72%), in stages 2 and 3, the average patient age being 59.29±11.52 years. Systemic manifestations were present in patients who underwent biological therapy, presented seropositive disease forms, as well as a more aggresive evolution and a more decreased BMI. Female patients more frequently presented ischemic heart disease, dyslipidemia and increased cholesterol levels, thus comprising multiple cardiovascular risk factors as well as associated cardiovascular pathology. Patients treated with biological therapy have presented a significantly lower incidence of ischemic stroke as well as slightly decreased cholesterol levels, data which correlate with specialty literature. Treatment using statins was more frequently used in these cases. Although statistically unsignificant, the most decreased cholesterol levels were recorded in patients treated with etanercept. Smokers presented a weaker response to biological therapy as compared to non-smokers. Osteoporosis was more frequent in the group of patients treated with classical remissive therapy as well as in those with an increased disease activity, evaluated through the DAS 28 score and increased inflammation markers. DAS 28 was decreased in patients treated with biological treatment (infliximab, adalimumab, rituximab), and those in the third stage of disease, probably because of the more aggeresive treatement administered in these situations. Conclusions. Biological therapy has positively influenced disease evolution, patients presenting decreased values for inflammation markers as well as disease activity, evaluated using the DAS 28 score, in comparison with patients treated with classical remissive therapy. Cholesterol levels were lower in the group treated with biological therapy, as patients underwent statin treatment more frequently, thus presenting a reduced incidence of stroke. Moreover, osteoporosis was less frequent in the group treated with biological agents. These biological therapies did not influence the number of viral hepatitis infections, but in some cases have determined the reactivation of a series of tuberculosis infections. Neoplasms have not presented a significantly increased incidence in the group treated with biological therapy. Adverse effects of biological treatment will be further studied, but the beneficial effect on disease evolution as well as other disease-associated risks is certain.