TÜRKAN TURGAY, Ali AYDENİZ, Savaş GÜRSOY

Romatoid Artritli Hastalarda Anti TNF ve DMARD Tedavilerinin Hastalık Aktivite ve İyileşme Kriterlerine Göre Karşılaştırılması

Bu çalışmada romatoid artrit (RA) tedavisinde eklem hasarının önlenmesi veya kontrol altına alınması yoluyla DMARD (Disease Modifying Anti-Rheumatismal Drug) grubu ilaçlar ve metotreksat ile kombine anti TNF (Tümör Nekroz Faktör) ilaç tedavisinin hastalık aktivite kriterlerine göre etkinliğini kıyasladık. Çalışmamıza 24 hafta süre ile takip edilmiş verileri eksiksiz 75 aktif RA hastası alındı. Hastaların demografik özellikleri, DAS28 (Disease Activity Score), VAS (Visual Analogue Scale), HAQ (Health Assessment Questionnaire) parametreleri ve laboratuar değerlendirmeleri retrospektif olarak dosyalarından kaydedildi. Hastalar metotreksatla kombine anti TNF (infliksimab, etanersept, adalimumab) alan 37 hasta; DMARD (leflunomid+metotreksat, sulfasalasin+metotreksat, sadece metotreksat) alan 38 hasta olmak üzere 2 ayrı grupta incelendi. Tedavi etkinliği ACR (American College of Rheumatology) 20, 50 ve 70 kriterleriyle hesaplandı. Kombine anti TNF ilaç ile DMARD kullanan hastaların yaş ortalaması sırasıyla 50.27±7.9 ve 46.79±8.6 olarak hesaplanmıştır. Gruplar arasında tedavi öncesinde bakılan parametrelerden sadece HAQ arasında istatistiksel olarak anlamlı farklılık saptanmıştır. Gruplar arasında bakılan tedavi öncesi ve sonrası parametreler her iki grupta azalma göstermektedir ancak bu azalma kombine anti TNF tedavisi alan grupta DMARD grubundan istatistiksel olarak daha anlamlı bulunmuştur. Her iki grup arasında 6. ay kontrollerinde bakılan DAS28, VAS ve HAQ değerlerinde istatistiksel olarak anlamlı farklılık saptanmıştır. ACR 20, 50 ve 70 cevapları metotreksat ile kombine anti TNF ilaç alan grupta sırasıyla %81, 54 ve 22 iken; DMARD alan grupta %44, 15 ve 0 olarak saptanmıştır (p<0.001). Metotreksat ile kombine edildiğinde anti TNF ilaçların, DMARD’lara kıyasla hastalık aktivitesini azaltmada, fonksiyonel özürlülüğü iyileştirmede ve ACR yanıtlarında istatistiksel olarak daha etkin olduğu bulunmuştur.

Anahtar Kelimeler:

Anti TNF İlaçlar, DMARD, Romatoid Artrit

The Comparison of Treatment Results of Rheumatoid Arthritis with DMARDs and Anti TNF Drugs Based on the Disease Activity and Remission Criteria

We aimed to compare the effectiveness of DMARD (Disease Modifying Anti-Rheumatismal Drug) drugs and methotrexate combined anti-TNF (Tumor Necrosis Factor) treatment on disease activity criteria in preventing or controlling joint damage in rheumatoid arthritis (RA). Seventy-five active RA patients followed for 24 weeks were included in the study. The demographic features, DAS28 (Disease Activity Score), VAS (Visual Analogue Scale), HAQ (Health Assessment Questionnaire) parameters and laboratory values were recorded from their files retrospectively. Patients were divided into two groups: 37 receiving anti-TNF (infliximab, etanercept, adalimumab) combined with methotrexate and 38 receiving DMARD (leflunomide+methotrexate, sulfasalacin+methotrexate, methotrexate only). The therapeutic efficacy was evaluated by American College of Rheumatology (ACR) 20, 50 and 70 criteria. The mean age of patients using combined anti-TNF drug and DMARD was 50.27±7.9 and 46.79±8.6, respectively. There was a statistically significant difference between the groups only in HAQ score before treatment. Pre- and post-treatment parameters showed a decrease in both groups, but this decrease was statistically significant in the group receiving combined anti-TNF treatment than the DMARD group. DAS28, VAS and HAQ values were statistically different between the two groups at the 6th month follow-up. ACR 20, 50 and 70 responses were 81, 54 and 22% in the group receiving anti-TNF drug combined with methotrexate; 44, 15 and 0% in the patients receiving DMARD (p<0.001). Anti-TNF drugs, when combined with methotrexate, were found to be more effective in reducing disease activity, improving functional disability, and ACR responses than DMARDs.

Keywords:

Anti TNF Drugs, DMARDs, Rheumatoid Arthritis,

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