Clinical and Laboratory Evaluation of Response to Biological Agents in Rheumatoid Arthritis and Ankylosing Spondylitis

Our aim was to evaluate the anti-tumor necrosis factor (TNF) response to treatment, which has been in place in the treatment of Rheumatoid Arthritis(RA) andAnkylosing Spondylitis(AS) patients in recent years and has achieved successful results. In this regard, the follow-up of the disease is more predictable after the initiation of anti-TNF therapy; it is aimed to interpret the parameters used in follow-up more correctly.This cross-sectional, retrospective study was performed in auniversity hospital between 2010-2016. Files of 24 patients with AS and 53 patients with RAwere retrospectively screened. Their clinical situations and laboratory levels were compared before and after the biological agent treatment. Treatment response with RA was evaluated by Disease Activity Score-28 (DAS28) scale and AS patients’ treatment response was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scale..A total of 77 patients were included in the study. Of the participants, 53 were diagnosed as RA and 24 were diagnosed as AS. After our study we have determined statistically reasonable decrease in C-Reactive protein (CRP), white blood cell (wbc), Platelete, erythrocyte sedimentation rate (ESR) levels but an increase in blood urea nitrogene (BUN), haemoglobine (Hb), Albumin levels. The mean baseline score of BASDAI assessed before the treatment in 24 patients with AS was 6.08 and after the treatment was 3.42; DAS-28 assessed before the treatment was 5,77 and after the treatment was 3,58 and these differences was statistically significant. Patients treated with biological agents showed a significant improvement in clinical assessment evaluated by BASDAI in patients with AS and DAS28 in patients with RA. Significant decrease in CRP, ESH, wbc levels, improvement in chronic disease anemia, increase in albumin level as a negative acute phase reactant and decrease in thrombocyte levels were determined because of acute phase response and regression of inflammation.

Keywords:

BASDAI, DAS28 Ankylosing spondylitis, Rheumatoid arthritis,

PDF

___

1. Feldtkeller E, Khan MA, van der Heijde D, van der Linden S, Braun J. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int. 2003; 23: 61–6.
2. Özgöçmen S. Ankilozan Spondilitin Klinik ve Laboratuvar Bulguları. Ataman Ş, Yalçın P (Editörler). Romatoloji. Ankara: MN Medikal & Nobel kitabevi; 2012, s.583-96.
3. Redlich K, Görtz B, Hayer S et al: Overexpression of tumor necrosis factor causes bilateral sacroiliitis.Arthritis Rheum. 2004;50:1001-5).
4. Lipsky PE. Rheumatoid Arthritis. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL editors. Harrıson’s Principles of Internal Medicine. New York: McGraw-Hill; 2005. p. 1968-1977.
5. Hellmann DB, Stone JH. Rheumatoid Arthritis. In: Tierney LM, McPhee SJ, Papadakis MA editors. Current Medical Diagnosis & Treatment. New York: McGraw-Hill; 2005. 801-807.
6. Lipsky PE, van der Heijde D, St. Clair EW et al, and the Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthriti with Concomitant Therapy Study Group. Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Eng J Med 2000; 343:1594-602.
7. Ergin S. Romaroid Artrit. In: Beyazova M, Kutsal Y G. (ed).Fiziksel Tıp Ve Rehabilitasyon. Ankara Güneş Kitabevleri 2011.p: 2199-2220.
8. Braun J, Baraliakos X, Golder W et al. Analysing chronic spinal changes in ankylosing spondylitis: a systematic comparison of conventional x rays with magnetic resonance imaging using established and new scoring systems. Ann Rheum Dis 2004;63(9):1046-55.
9. Dernis E, Lavie F, Pavy S et al. Clinical and laboratory follow-up for treating and monitoring patients with ankylosing spondylitis: development of recommendations for clinical practice. Joint Bone Spine. 2007;74(4):330-7.
10. Guidelines for the Management of Rheumatoid Arthritis 2002 Update American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines, Arthritis Rheum Vol. 46, No. 2, February 2002, pp 328–346.
11.http://www.rheumatology.org/practice/clinical/classification/ra/ra_2010.asp.
12. Hamuryudan V. Đ.Ü.Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri, Türkiyede sık karşılaşılan hastalıklar dizisi, Enfeksiyon Hastalıkları, Romatizmal Hastalıklar, Afetlerde Ezilme Yaralanmaları Sempozyum Dizisi No: 55, Ocak 2007; s. 69-86.
13. P.Alex ve ark. ,Multiplex serum cytokine monitoring as a prognostic tool in rheumatoid arthritis, Clinical and Experimental Rheumatology 2007; 25; 584-592.
14. Brandt J, Khariouzov A, Listing J, Haibel H, Sörensen H, Grassnickel L, et al. Six-month results of a double-blind, placebo-controlled trial of etanercept treatment in patients with active ankylosing spondylitis.Arthritis Rheum. 2003;48:1667-75.
15. Kennedy LG, Edmunds L, Calin A. The Natural History of ankylosing spondylitis. Does it burn out? J Rheumatol 1993;20:688-92.
16. Hobbs K, Deodhar A, Wang B, et al. Randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of etanercept in patients with moderately active rheumatoid arthritis despite DMARD therapy. SpringerPlus. 2015;4:113. doi:10.1186/s40064-015-0895- 9.
17. Herenius MMJ, Oliveira ASF, Wijbrandts CA, Gerlag DM, Tak PP, Lebre MC. Anti-TNF Therapy Reduces Serum Levels of Chemerin in Rheumatoid Arthritis: A New Mechanism by Which Anti-TNF Might Reduce Inflammation. Frey O, ed. PLoS ONE. 2013;8(2):e57802. doi:10.1371/journal.pone.0057802.
18. Wang F, Yan CG, Xiang HY, Xing T, Wang NS. The significance of platelet activation in ankylosing spondylitis. Clin Rheumatol 2008;27(6):767-9.
19. Mathieu S, Joly H, Baron G, Tournadre A, Dubost JJ, Ristori JM, et al. Trend towards increased arterial stiffness or intima-media thickness in ankylosing spondylitis patients without clinically evident cardiovascular disease. Rheumatology 2008;47(8):1203.
20. Doyle MK, Rahman MU, Han C, et al. Treatment with infliximab plus methotrexate improves anemia in patients with rheumatoid arthritis independent of improvement in other clinical outcome measures. Semin Arthritis Rheum.2008;39:123–31.
21. Wolfe F, Michaud K. Anemia and renal function in patients with rheumatoid arthritis. J Rheumatol.2006;33:1516–22.
22. Demirag MD, Haznedaroglu S, Sancak B, Konca C, Gulbahar O, et al. (2009) Circulating hepcidin in the crossroads of anemia and inflammation associated with rheumatoid arthritis. Intern Med 48: 421–426.
23. Heiberg M.s, Nordvag B.Y, Mikkelsen K, Rodevand E, Kaufmann C, Mowinckel P, Kvien T.K. The comperative effectiveness of tumor necrosis factor-blocking agents in patients with rheumatoid arthritis and patients with ankylosing spondylitis; a six-month, longitudinal, observational, multicenter study. Arthritis Rheum 2005:52;2506-12.
24. Brandt J, Listing J, Haibel H, et al. Long-term efficacy and safety of etanercept after readministration in patients with active ankylosing spondylitis. Rheum 2005;44:342-348.
25. Baraliakos X, Brandt J, Listing, et al. Outcome of patients with active ankylosing spondylitis after two years of therapy with etanercept: clinical and magnetic resonance imaging data. Arthritis Rheum 2005;53:856-63.
26. Davis JC, van der Heijde DM, Braun J, et al. Sustained durability and tolerability of etanercept in ankylosing spondylitis for 96 weeks. Ann Rheum Dis2005;64:1557-1562.
27. Smolen JS, Aletaha D. Interleukin-6 receptor inhibition with tocilizumab and attainment of disease remission in rheumatoid arthritis: the role of acute-phase reactants. Arthritis Rheum. 2011 Jan;63(1):43-52. doi: 10.1002/art.27740.
28. Schiff M, Pritchard C, Huffstutter JE et al. The 6-month safety and efficacy of abatacept in patients with rheumatoid arthritis who underwent a washout after anti-tumour necrosis factor therapy or were directly switched to abatacept: the ARRIVE trial. Annals of the Rheumatic Diseases 2009;68:1708-1714.
29. Yang CH, Effects of infliximab and etanercept, two types of anti-TNFalpha inhibitor on serum level of MMP-3 expression in patients with ankylosing spondylitis Zhonghua Yi Xue Za Zhi. 2006 Sep 19;86:2451-4.
30. Van der Heijde D, Kivitz A, Schiff MH et al and the ATLAS Study Group. Efficacy and safety of adalimumab in patients with ankylosing spondylitis: Arthritis Rheum 2006; 54: 2136–46.
31. Van Der Heijde D, Dijkmans B, Geusens P. Et al. The ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy Study Group. Efficacy and safety of infliximab in patients with AS (ASSERT). Artritis Rheum2005;52:582-91.