SAT0139 The preventive effect of infliximab on progression of occipito-cervical lesion in RA patients
Authors: K. Ijiri, K. Takahashi, N. Sunahara, E. Taketomi, S. Sakashita, M. Koiso, S. Komiya
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Rheumatoid arthritis (RA) is a chronic, progressive, and inflammatory disease, resulting severe joint destruction. Recent reports on the treatment of anti-TNF-a agent have shown strong clinical efficacy in preventing destruction in joints of extremities. However, few reports are available to evaluate the efficacy on cervical lesions in RA. <h3>Objectives</h3> We therefore performed the clinical and radiological study for RA patients with cervical lesions, who received the treatment with infliximab more than 3 years. <h3>Methods</h3> Fifty one patients, who met the 1987 revised criteria of the American College of Rheumatology for the classification of RA, were studied prospectively. Infliximab 3mg/kg/week (Remicade; Centocor, Malvern, PA) was supplied continuously more than 3 years for 31 patients (IFX group). All patients in IFX group were treated with concomitant MTX (mean 7.1mg/week). Twenty patients, who were treated with MTX (mean 7.1mg/week) without infliximab were studied as control (Cont group). Disease Activity Score (DAS) 28-CRP was monitored throughout the period, and EULAR (European League Against Rheumatism) response rate was examined. Radiological parameters, including the atlanto-dental interval, Ranawat's value and SS (subaxial subluxation: &gt;3.5 mm) were determined using lateral-view plain radiographs. Statistical analysis was performed using Mann-Whitney <i>U</i>test and χ<sup>2</sup> test. <h3>Results</h3> At baseline, two groups were comparable with respect to demographic characteristics, however, more patients were in high disease activity in IFX group than Cont group. DAS28-CRP values were improved statistically in IFX group (P=0.0001), but not in Cont group (P=0.90). The progression of atlantoaxial subluxation (AAS) was not observed in both groups. On the other hand, the progression of vertical subluxation (VS) was observed in Cont group (P&lt;0.01) but not in IFX group (P=0.29). And the progression of SS was also observed in Cont group but not in IFX group (P&lt;0.05). <h3>Conclusions</h3> This study has shown that the treatment with infliximab can prevent the progression of cervical lesion in RA patients. Most of the patients in this study were advanced patients who had received DMARDs therapy or steroid therapy more than 3 years before this study. Recently, anti-TNF-a agent treatment is recommended for early stage of RA, since the repair of bone and articular destruction can be expected in such cases. The treatment with anti-TNF-a agent may prove to be highly effective strategy for preventing cervical lesion in patients at early stage of RA with high risk for disease progression. <h3>References</h3> Moreland LW, Schiff MH, Baumgartner SW, Tindall EA, Fleischmann RM, Bulpitt KJ, et al. Ann Intern Med 1999;130;478-86. Weinbalatt ME, Kremer JM, Bankhurst AD, Bulpitt KJ, Fleischmann Rm, Fox RI, et al. N Engl J Med 1999;340:253-9. Maini R, St. Clair EW, Breedveld F, Furst D, Kalden J, Weisman M et al. Lancet 1999;354:1932-9. Lipsky PE, van der Heijde DM, St Clair EW, Furst DE, Breedveld FC, Kalden JR, et al. N Engl J Med 2000;343:1594-602. Weiblatt ME, Keystone EC, Furst DE, Moreland LW, Weisman MH, Birbara CA et al. Arthritis Rheum 2003;48:35-45. <h3>Disclosure of Interest</h3> None Declared