AB0477 Inhibition of large joint destruction in rheumatoid arthritis patients treated with tocilizumab
Authors: Y. Hirano, K. Hattori, R. Yamada
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Rheumatoid arthritis (RA) causes not only inflammation of small joints, such as hands and feet, but also inflammation of large joints. Destruction of large joints is correlated with impairments of physical activity in RA patients more than destruction of small joints is <sup>(1)</sup>. We experience strong inhibitory effect of inflammation in synovial joints, not only small joints but also large joints, by treatment with tocilizumab (TCZ), an antibody to IL-6 receptor in RA patients in daily clinical practice. Although inhibitory effects of small joint destruction by TCZ is well known, inhibitory effects of large joint destruction is unknown. <h3>Objectives</h3> This retrospective study investigated inhibitory effect of large joint destruction by TCZ treatment in RA patients. <h3>Methods</h3> Toyohashi RA database (TRAD) was used. TCZ was initiated in 65 RA patients in our institute. 31 cases (23 female and 8 male) who continued TCZ over 2 years were utilised in this study. Baseline characteristics and time course of disease activity were investigated. Delta-modified Sharp score (ΔmTSS) per year was used to evaluate small joint destruction. ARASHI score <sup>(2)</sup> was used to evaluate large joints destruction. Shoulders, elbows, hips, knees and ankles were evaluated using ARASHI score. <h3>Results</h3> Treatment continuation rate of TCZ was 86.3% at one year and 77.7% at two years in whole 65 cases (Kaplan-Meier methods). Baseline characteristics of 31 cases was as followed. Average age: 56 years old. Average RA duration: 6.6 years. Concomitant rate of MTX: 74.2%. Concomitant rate of prednisolone: 64.5%. Order of TCZ: 1st biologics in 9 cases, 2nd biologics in 9 cases, 3rd biologics in 13 cases. Rates of symptomatic joints (pain or swelling): 45.1% in shoulders, 44.6% in elbows, 0.0% in hips, 51.9% in knees and 37.7% in ankles. Average CDAI was 23.3 at baseline, 6.8 at one year and 5.0 at two years. Average ΔmTSS was 8.1 at baseline, 2.7 from baseline to one year and 1.1 from one year to two years. Evaluation using ARASHI change score from baseline to two years was as followed [worsened. not changed, improved (%)]. Shoulders (51 joints) [9.8, 86.3, 3.9]. Elbows (56 joints) [12.5, 73.2, 14.3]. Hips (53 joints) [0, 94.3, 5.7]. Knees (52 joints) [9.6, 65.4, 25.0]. Ankles (53 joints) [3.8, 91.6, 5.7]. Joint surgery was not performed in evaluated joints during study periods. Influence of symptoms at baseline on large joint destruction: There was a significant difference between ARASHI change score in symptomatic knee joints and that in non-symptomatic joints (−0.5 vs. 0.1, p&lt;0.01). <h3>Conclusions</h3> Over 90% of large joints was not destructed during two-year TCZ treatment. Improvement was frequently observed in knees and elbows. Major reasons of improvement of joint destruction were stabilisation of joints by osteophyte formation and repair of bone erosions. <h3>References</h3> [1] Drossaers-Bakker, et al. Rheumatology2000. [2] Kaneko, et al. Mod Rheumatol2013. <h3>Disclosure of Interest</h3> Y. Hirano Speakers bureau: Chugai pharma., K. Hattori: None declared, R. Yamada: None declared