Choice of and response to treatment in patients with early-diagnosed rheumatoid arthritis: Real-world data from an inception cohort in Japan (NICER-J)

OBJECTIVE

Various guidelines recommend that patients with early rheumatoid arthritis (RA) try to achieve clinical remission within 6 months, and early therapeutic intervention is important to this end. This study aimed to investigate short-term treatment outcomes of patients with early-diagnosed RA in clinical practice and to examine predictive factors for achieving remission.

METHODS

Of the 210 patients enrolled in the multicenter RA inception cohort, 172 patients who were followed up to 6 months after treatment initiation (baseline) were included. Logistic regression analysis was used to examine the impact of baseline characteristics on achievement of Boolean remission at 6 months.

RESULTS

Participants (mean age, 62 years) initiated treatment after a mean of 19 days from RA diagnosis. At baseline and 3 and 6 months after treatment initiation, proportions of patients using methotrexate (MTX) were 87.8%, 89.0%, and 88.3%, respectively, and rates of Boolean remission were 1.8%, 27.8%, and 34.5%, respectively. Multivariate analysis revealed that physician global assessment (PhGA) (Odds ratio (OR): 0.84, 95% confidence interval (CI): 0.71-0.99) and glucocorticoid use (OR: 0.26, 95% CI: 0.10-0.65) at baseline were independent factors that predicted Boolean remission at 6 months.

CONCLUSION

After a diagnosis of RA, satisfactory therapeutic effects were achieved at 6 months after the initiation of treatment centered on MTX according to the treat to target strategy. PhGA and glucocorticoid use at treatment initiation are useful for predicting the achievement of treatment goals.

Comparison of effectiveness of methotrexate in patients with late-onset versus younger-onset rheumatoid arthritis: Real-world data from an inception cohort in Japan (NICER-J)

OBJECTIVE

To compare the effectiveness of methotrexate (MTX) as initial therapy in patients with late-onset and younger-onset rheumatoid arthritis (LORA and YORA).

METHODS

Of 114 patients with YORA and 96 patients with LORA, defined as RA occurring at ≥65 years of age, enrolled in a multicentre RA inception cohort study, 71 and 66 patients who had been followed up to 6 months after starting MTX treatment were included in this study.

RESULTS

Proportions of patients on MTX treatment at 6 months were 96% and 92% in the YORA and LORA groups, respectively. Despite lower doses of MTX in the LORA group compared with the YORA group, no significant difference was observed in clinical disease activity index scores between the two groups throughout the follow-up period. The proportion of patients in clinical disease activity index remission at 6 months was 35% in both groups. Logistic regression analysis revealed that knee joint involvement and high Health Assessment Questionnaire-Disability Index were significant negative predictors of achieving clinical disease activity index remission at 6 months in the LORA group.

CONCLUSION

Observations up to 6 months revealed that the effectiveness of MTX administered based on rheumatologist discretion in patients with LORA is comparable to that in patients with YORA in clinical settings.

AB0362 HERPES ZOSTER IN BARICITINIB-TREATED JAPANESE PATIENTS WITH RHEUMATOID ARTHRITIS USING REAL-WORLD CLINICAL DATA

Background:

Similar to biologic disease-modifying anti-rheumatic drugs, the association between Janus kinase (JAK) inhibitors and infection is particularly interesting. The incidence of herpes zoster (HZ) among patients treated with JAK inhibitors is twofold to threefold higher in several regions of Asia (e.g., Japan and Korea) as compared with that observed in North America and Western Europe [1].

Objectives:

To evaluate the characteristics of patients who developed HZ during baricitinib treatment using real-world, multicenter, clinical data for Japanese population.

Methods:

The study enrolled 97 patients with rheumatoid arthritis (RA) who were treated with baricitinib therapy (68 biologic-naïve patients and 29 biologic-experienced patients) were enrolled in the study (observation period: 2–27 months). The severity of HZ infection was determined based on the extent of the rash and the presence or absence of organ damage. We evaluated the characteristics and clinical courses of patients who developed HZ.

Results:

Eight patients with HZ. The incidence ratio (IR) was 8.2 per patient-year. Patient data are described in Table 1 and Table 2. The IR was a little higher than that reported in clinical trials [2], which could be attributed to the high average age (i.e., 67.3 years) of the patients in this study. It was reported that adverse events occurred more frequently in elderly patients aged ≥65 years compared with younger patients [3]. The period from baricitinib administration to the onset of HZ varied between 2 months and 16 months. It is suggested that HZ may develop at any time during baricitinib therapy. There were no distinctive patient characteristics, except for age, at the time of initial baricitinib administration between patients who developed HZ and those who did not.

Table 2.

Response rates of non-medical Switch from Cellcept to Myfortic

Case- No.Age (years)Time (years) from RA onsetGenderFemale:FMale: M)BMIBari dose (mg/d)PSL(mg/d)MTX (mg/w)HZ historyNumber of prior biologics1741.5F25.64012No226133F19.2206No136111.1F23.64010Yes04730.5M23.3408Yes057421.9F20.9200No06781.2F19.8406No074823.2F24.1448No08795.0F22.422.54No0Table 1.

Fatigue in NPSLE and non-NPSLE patients (N = 222)

Case No.HZ incidence period after baricitinib administration (months)Priod of baricitinib withdrawal (weeks)Severity(Mild; MilModerate: Mod)1164Mod224Mod3131Mil431Mil586Mod634Mil ~ Mod733Mod820Discontinuation due to pateient’s choiceMod

None of the patients had severe symptoms, and none of them experienced organ damage. All patients were cured with anti-viral agents. It should be noted that patients who had a history of HZ had milder symptoms than those who had no history of HZ. We noted an interesting finding in one patient (case 2). The half-life of baricitinib in the blood was very short (about 6 hours), and it is reported that the drug is almost fully excreted from the body 24 hours after its administration [4]. However, this patient developed an incidence of HZ at 17 days after the withdrawal of baricitinib for surgery management. Cells may take longer time to regain their original immune status even after excretion of the drug, especially, during intense stress such as in cases of surgical invasion.

Conclusion:

The HZ risk in Japanese patients with RA treated with baricitinib in real-world practice was high, especially in elderly patients. It is notable that HZ events were nonserious and that patients could restart baricitinib treatment after healing with antiviral therapy, for the most part.

References:

[1]Taylor PC et al. N Engl J Med. 2017;376:652-62

[2]Harigai M et al. Mod Reumatol. 2019;20:1-8.

[3]Fleischmann R et al. RMD open. 2017;3:e000546.

[4]Shi JG et al. J Clin Pharmacol. 2014;54:1354-61

Disclosure of Interests:

Eiji Torikai: None declared, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Daisuke Suzuki: None declared, Yasuhide Kanayama: None declared

SAT0156 EFFECTIVE OF BARICITINIB ON RADIOGRAPHIC PROGRESSION OF STRUCTURAL JOINT DAMAGE AT 48 WEEKS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-WORLD MULTICENTER CLINICAL DATA

Background:

Baricitinib (bari) is an oral Janus kinase 1 (JAK1)/JAK2 selective inhibitor that has demonstrated good efficacy in patients with rheumatoid arthritis (RA) and adequate response to conventional synthetic (cs) DMARDs in some clinical trials [1,2]. We report the efficacy and safety of bari within 24 weeks in real-world clinical data at EULAR2019.

Objectives:

To evaluate the radiographic progression of structural joint damage at 48 weeks in Japanese patients with RA in real-world multicenter clinical data.

Methods:

We included 53 Japanese patients with RA who showed an inadequate response to csDMARDs or biologic (b) DMARDs. Patients were scheduled to receive a once-daily dose of 4 or 2 mg/day bari as monotherapy or in combination with other csDMARDs. We divided the patients into two groups: those treated with 2 mg/day of bari (2mg-group; n = 27) and those treated with 4 mg/day of bari (4-mg group; n = 26) throughout the observation period. Patients were allowed to decrease their predonisolone and csDMARDs combined with bari treatment if their disease activity improved. First, we evaluated changes in CDAI and HAQ-DI after 48 weeks. Second, we evaluated the change in the van der Heijdge modified total sharp score (ΔmTSS), erosion score (ΔERN), and joint space narrowing score (ΔJSN). In addition, we assessed predictors for suppression of joint destruction at 48 weeks after bari treatment.

Results:

The baseline characteristics of the patients were as summarized in Table 1. There were no significant differences in any items. CDAI scores significantly improved 4 weeks after the treatment. This tendency continued until the final evaluation (Table 2). At 48 weeks, remission and low disease activity rates were 37.0% and 74.1% in the 2-mg group and 38.4% and 76.9% in the 4-mg group, respectively. Structural remission (mTSS ≤ 0.5) was noted in 21 patients (80.8%) and 21 patients (77.8%) in 4-mg group and 2-mg group, respectively (Figure). Mean scores (ΔmTSS, ΔERN, and ΔJSN) of all patients in the 2-mg group and 4-mg groups were (0.26, 0.15, and 0.11), (0.30, 0.17, and 0.13) and (0.23, 0.13, and 0.10), respectively (Figure). There were no significant differences in ΔmTSS scores between the two groups. A matrix metalloproteinase-3 score within the standard value at 12 weeks after the treatment was associated with a predictor for suppression of joint destruction at 48 weeks (logistic regression analysis; odds ratio = 11.6, 95% confidence interval: 1.5–112.4,P= 0.020).

Table 1.

Characteristics of patients at baricitinib initiation

2mg-group (n=27)4mg-group (n=26)p-valueAge (years)69.1 (12.0)65.6 (10.3)0.20Gender, female, n (%)19 (73.1)23 (85.2)0.28Disease duration (years),9.7 (10.4)5.7 (7.4)0.23Prior use of biologics, (0/1/2/3)(18/6/2/1)(18/2/5/1)------MTX (mg/week),4.5 (3.7)6.5 (4.29)0.08PSL (mg/day)1.0 (1.9)1.2 (1.8)0.49RF, U/ml254 (372)134 (222)0.21ACPA, U/m152 (176)133 (301)0.45MMP-3196 (220)215 (221)0.43Table 2.

Serial change of clinical assessment

2mg-groupBaseline4 week12 week24 week48 weekCDAI22.5 (9.2)7.4 (7.7)6.7 (6.9)6.9 (6.8)6.9 (6.8)HAQ-DI0.88 (0.51)0.45 (0.47)0.53 (0.58)0.56 (0.56)0.56 (0.56)MMP-3196 (221)98.9 (62.2)115 (164)106 (78)106 (78)4mg-groupBaseline4 week12 week24 week48 weekCDAI24.4 (9.7)9.4 (5.7)8.6 (6.3)6.7 (8.6)6.8 (8.6)HAQ-DI1.01 (0.51)0.58 (0.48)0.54 (0.60)0.45 (0.49)0.44 (0.45)MMP-3216 (222)99 (62)101 (123)89 (72)95 (81)

Conclusion:

The data showed that bari has a favorable effect on the radiographic progression of structural joint damage regardless of its dose in a real-world clinical setting. In consideration of the risk/benefit balance, we suggest that the dose of bari could be reduced in patients with favorable disease activity.

References:

[1]Tanaka Y et al. Mod Rheumatol. 2018;28:583-91

[2]Tanaka Y et al. Mod Rheumatol. 2018;28:20-9

Disclosure of Interests:

Eiji Torikai: None declared, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Daisuke Suzuki: None declared, Yasuhide Kanayama: None declared

FRI0137 Discontinuation of baricitinib after achieving low disease activity in patients with rheumatoid arthritis in clinical practice; a multicenter observational study

Background:

Baricitinib (bari) is an oral Janus kinase (JAK) 1/JAK2 selective inhibitor that has shown good efficacy in patients with RA and adequate response to conventional synthetic DMARDs in some clinical trials [1,2]. However, concerning the high cost and long-term safety related to the inhibition of particular molecules, we would like to discontinue bari after achieving long low disease activity (LDA).

Objectives:

To evaluate the clinical outcomes in patients with RA who discontinued bari after achieving LDA for 24 weeks in real-world multicenter clinical data.

Methods:

Japanese 67 patients with RA who show an inadequate response to csDMARDs or bDMARDs were scheduled to receive bari 4 or 2 mg/day once daily dose as a monotherapy or in combination with other csDMARDs. We included 51 patients who achieved and maintained LDA at least for 24 weeks after baricitinib therapy. They were allowed to decrease baricitinib after discontinuation of prednisolone. Bari was either discontinued or continued after study enrolment. The decision of discontinuation and continuation of baricitinib was determined based on patient-physician decision making with informed consent. We divided patients into two groups: a discontinuation group (D group; n = 23) and a continuation group (C group; n = 28). We evaluated the proportion of patients who remained LDA for 24 weeks in both groups. Clinical outcomes including Clinical Disease Activity Index (CDAI), and HAQ-DI were compared between both groups. The last observational carried forward method was used for patients who could not discontinue baricitinib due to flare before 24 weeks. In D group, patients were treated with re-initiation of bari or initiation of the other DMARDs in the event of flare. We investigated the serial changes of patients treated with re-initiation of bari in CDAI after flare.

Results:

The baseline characteristics of the patients are summarized in Table. The titer of RF was lower in D group than that in C group. There were no significant differences in any other items. Ten of 23 (43.4%) in D group remained bari-free without disease activity flare. Serial changes of CDAI were summarized in Figure. CDAI in D group significantly increased from 3.6 at baseline to 9.8 at last observation. LDA rates in C group were 92.9% at last observation. CDAI in C group did not change throughout the follow-up period. CDAI at last observation was higher in D group than that in C group. HAQ-DI in D group changed from 0.28 at baseline to 0.45 at last observation. There was no significant change in HAQ-DI between both groups (P = 0.28). In D group, rescue by re-administration of bari or other DMARDs induced improvement, reducing CDAI from 15.5 at disease flare to 6.8. Especially, all patients treated with re-initiation of bari resulted in re-introduction of LDA in this study.

Table.

Characteristics of patients at baricitinib initiation

D group (n=23)C group (n=28)p-valueAge (years)66.9 (8.6)67.9 (12.7)0.31Gender, female, n (%)6 (73.9)24 (85.7)0.49Disease duration (years)7.6 (10.3)8.3 (9.9)0.37Prior use of biologics, n (0/1/2/≥3)(21/2/0/0)(17/6/4/1)------MTX (mg/w)5.5 (3.8)4.9 (4.3)0.62PSL (mg/d)1.4 (1.9)0.9 (0.9)0.51RF, U/ml99 (141)187 (214)0.04ACPA, U/ml135 (173)194 (214)0.11CDAI24.4 (9.2)22.5 (9.7)0.36HAQ-DI0.83 (0.49)0.83 (0.52)0.98

Conclusion:

It was possible to discontinue bari without flare in about 43% of patients with RA. Overall the patients treated with re-initiation of bari could result in re-introduction of LDA without deterioration of HAQ-DI.

References:

[1]Tanaka Y et al. Mod Rheumatol. 2018;28:583-91

[2]Tanaka Y et al. Mod Rheumatol. 2018;28:20-9

Disclosure of Interests:

Eiji Torikai: None declared, Yuji Hirano Speakers bureau: Tanabe-Mitsubishi, Pfizer, Eisai, Abbie, Chugai, Bristol-Meyers, Jansen, Astellas, UCB, Eli-Lilly, Asahikasei, Daiichi-Sankyo, Amgen, Daisuke Suzuki: None declared, Yasuhide Kanayama: None declared

New precise measurements of muonium hyperfine structure at J-PARC MUSE

High precision measurements of the ground state hyperfine structure (HFS) of muonium is a stringent tool for testing bound-state quantum electrodynamics (QED) theory, determining fundamental constants of the muon magnetic moment and mass, and searches for new physics. Muonium is the most suitable system to test QED because both theoretical and experimental values can be precisely determined. Previous measurements were performed decades ago at LAMPF with uncertainties mostly dominated by statistical errors. At the J-PARC Muon Science Facility (MUSE), the MuSEUM collaboration is planning complementary measurements of muonium HFS both at zero and high magnetic field. The new high-intensity muon beam that will soon be available at H-Line will provide an opportunity to improve the precision of these measurements by one order of magnitude. An overview of the different aspects of these new muonium HFS measurements, the current status of the preparation for high-field measurements, and the latest results at zero field are presented.

Involvement of IL-33 in the pathogenesis of rheumatoid arthritis: the effect of etanercept on the serum levels of IL-33

To investigate the role of interleukin (IL)-33 in rheumatoid arthritis (RA) patients, we measured the serum levels of IL-33 in RA patients before and after the administration of etanercept. Twenty-four patients with RA were treated with etanercept. Clinical and laboratory examinations, including serum levels of C-reactive protein (CRP) and hemoglobin (Hb); white blood cell (WBC) and red blood cell (RBC) counts; and the Disease Activity Score of 28 joints including CRP (DAS28-CRP), were performed at the baseline and at 3 and 6 months after the initial treatment with etanercept. The mean serum IL-33 levels had decreased significantly at 3 and 6 months after the initial treatment with etanercept. Serum IL-33 levels showed a significant correlation with the number of tender joints, CRP, DAS28-CRP, and the WBC count, and an inverse correlation with the RBC count and Hb level. These findings indicated that the decrease of serum IL-33 levels was a novel function of etanercept, shown for the first time in this study. Measurement of serum levels of IL-33 may become a useful control marker for RA treatment.

Arthroscopic treatment of a medial meniscal cyst using a posterior trans-septal approach: a case report

Arthroscopic partial menisectomy followed by cyst decompression is currently recommended for treatment of a meniscal cyst. However, it is doubtful whether partial menisectomy should be performed on cysts communicating with the joint in cases without a meniscal tear on its surface since meniscal function will be sacrificed. In this report, a meniscal cyst arising from the posterior horn of the medial meniscus without meniscal tear on its surface was resected using an arthroscopic posterior trans-septal approach. A 59 year-old male presented to our hospital with popliteal pain when standing up after squatting down. Magnetic resonance imaging revealed a multilobulated meniscal cyst arising from the posterior horn of the medial meniscus extending to the posterior septum with a grade 2 meniscal tear by Mink's classification. The medial meniscus was intact on the surface on arthroscopic examination. The meniscal cyst and posterior septum were successfully resected using a posterior trans-septal approach without harming the meniscus. This is the first report on a meniscal cyst being resected using an arthroscopic posterior trans-septal approach with a 9-month follow-up period.

Comparison between resection arthroplasty alone and resection arthroplasty with arthrodesis of the first MTP joint for rheumatoid forefoot deformities

It has been reported that nearly 90% of patients with rheumatoid arthritis (RA) have problems with their feet. Several methods of treating hallux valgus deformity in RA have previously been reported, including arthrodesis and joint resection, and good results have been observed with surgical procedures. In this report, we compare the clinical and radiological outcomes of resection arthroplasty alone (the first method) and resection arthroplasty with arthrodesis of the first MTP joint (the second method) for the treatment of forefoot deformities of RA patients. On clinical assessment, the American Orthopaedic Foot and Ankle Society (AOFAS) scale score significantly improved in both methods; however, the second method gave better results than the first method in relation to the footwear and alignment components. On radiographic assessment, in the first method there were no significant changes in the valgus angle (H-V angle) and the fifth metatarsal bone (M1/5) angle between preoperation and last follow-up. In contrast, these angles were decreased in the second method. One of the most important issues in the treatment of forefoot deformities in RA patients is to correct splaying foot deformity. We believe that the second method, which can correct splaying foot deformity, is currently the most reliable treatment method.

Reduction of oxidative stress marker levels by anti-TNF-alpha antibody, infliximab, in patients with rheumatoid arthritis

OBJECTIVE

The aim of this study was to evaluate the effects of anti-TNF-alpha antibody, infliximab, on oxidative stress markers representing DNA damage, lipid peroxidation, and glycoxidation.

METHODS

Twenty-three RA patients underwent infliximab treatment and were analyzed for 30 weeks. Six patients who experienced side effects and one patient who had a reduced efficacy of infliximab were discontinued the infliximab treatment at 30-54 weeks. Sixteen patients were analyzed for 54 weeks. The levels of serum total, urinary total, and free pentosidine, which is an advanced glycation end-product (AGE), and of urinary 15-Isoprostane F2t and 8-hydroxy-deoxy guanosine (8-OHdG) were determined at baseline and at 14, 30, and 54 weeks after initial treatment with infliximab.

RESULTS

Serum total, urinary total, and free pentosidine levels were reduced at 54 weeks after initial infliximab treatment. Urinary 15-Isoprostane F2t and 8-OHdG levels were also reduced at 14, 30, and 54 weeks. Urinary 8-OHdG levels in RA patients correlated with CRP and the Disease Activity Score of 28 joints.

CONCLUSION

In RA patients, infliximab plays an essential role as an anti-oxidative agent against AGE formation, oxidative DNA damage and lipid peroxydation.

Photodynamic therapy using talaporfin sodium for synovial membrane from rheumatoid arthritis patients and collagen-induced arthritis rats

We investigated the efficacy of photodynamic therapy (PDT) using talaporfin sodium as a new method of synovectomy for rheumatoid arthritis (RA). We first used RA synovial membrane (RASM) for in vitro and in vivo study. The RASM was obtained from patients with RA during total knee replacement. In the in vitro study, RA fibroblast-like synoviocytes (RASCs) obtained from the RASM were examined by fluorescent microscopy to measure the intracellular localization of talaporfin sodium. The cells were then subjected to PDT, and their viability was examined by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulphophenyl)-2H-tetrazolium inner salt assay. In the in vivo assay, RASM was obtained as described above, grafted onto severe combined immunodeficiency (SCID) mice and subjected to PDT. The damaged area of RASM was evaluated histologically at 1 day after PDT. Next, we performed a separate experiment using rats with collagen-induced arthritis (CIA). After intra-articular injection of talaporfin sodium, the concentration of talaporfin sodium accumulated in the CIA synovial membrane (CIASM) was compared with that in cartilage, periarticular muscle, and skin. We then performed PDT with intra-articular injection of talaporfin sodium and intra-articular irradiation. The damaged area of the CIASM was measured at 1 day after the PDT, and the articular histological and radiological changes of the ankle were observed at 56 days after the PDT. In RASM, talaporfin sodium accumulated in lysosomes in vitro, and the phototoxicity to RASCs in vitro and to RASM grafted onto SCID mice in vivo depended on the concentration of talaporfin sodium and the laser energy. In CIA rats, there was a greater accumulation of talaporfin sodium in the CIASM than in normal tissue. The CIASM was selectively damaged at 1 day after the PDT, and the bone and cartilage destruction were ameliorated at 56 days after the PDT. In conclusion, PDT using talaporfin sodium might be a new method for synovectomy in patients with RA.

Etanercept reduces the oxidative stress marker levels in patients with rheumatoid arthritis

This study was performed to evaluate the effects of the TNF-alpha inhibitor etanercept on oxidation stress markers representing DNA damage, lipid peroxidation, and protein glycosylation. Twenty-two rheumatoid arthritis (RA) patients underwent etanercept treatment. The levels of serum total, urinary total, and urinary free pentosidine, which is an advanced glycation end-product (AGE), of urinary N(epsilon)-hexanoyl lysine (N(epsilon)-HEL), and of 8-hydroxy-deoxy guanosine (8-OHdG) were measured at baseline and at 3 and 6 months after the initial treatment with etanercept. Serum total and urinary total pentosidine levels were reduced at 6 months after the initial treatment with etanercept, and urinary free pentosidine levels were reduced at 3 and 6 months. Urinary N(epsilon)-HEL levels were also reduced at 3 and 6 months, and urinary 8-OHdG levels were reduced at 6 months. Serum total and urinary total pentosidine levels in RA patients correlated with the number of swelling joints and tender joints, and urinary total pentosidine levels correlated with the Disease Activity Score using 28 joints (DAS28). This study demonstrated that etanercept acts as a regulator against pentosidine formation, oxidative DNA damage, and lipid peroxidation in RA patients.

Etanercept reduces the serum levels of interleukin-23 and macrophage inflammatory protein-3 alpha in patients with rheumatoid arthritis

The purpose of this study was to analyze the effect of the soluble TNF-alpha receptor etanercept on the serum levels of IL-16, IL-17, IL-23, and macrophage inflammatory protein-3alpha (MIP-3alpha) in rheumatoid arthritis (RA) patients. Twenty-two patients with RA were administered etanercept once or twice a week for more than 6 months, and we evaluated clinical and laboratory parameters and serum levels of IL-16, IL-17, IL-23, and MIP-3alpha at the baseline and at 3 and 6 months. Additionally, the production of IL-23 and MIP-3alpha of cultured synovial cells stimulated with TNF-alpha from RA patients was determined by ELISA. We also used ELISA kits to determine synovial fluid (SF) levels of IL-17, IL-23, and MIP-3alpha in patients with RA, osteoarthritis (OA), pseudogouty arthritis (PGA), and gouty arthritis (GA). A significant decrease in serum levels of IL-23 and MIP-3alpha was observed at 3 and 6 months after initial treatment of etanercept. TNF-alpha induced MIP-3alpha but not IL-23 production in cultured synovial cells from RA patients. SF levels of IL-17, IL-23, and MIP-3alpha in RA patients showed significantly higher levels than those of OA, PGA, and GA patients. This study demonstrated that the reduction of IL-23 and MIP-3alpha production in RA patients was a newly determined function of etanercept.

The effect of methotrexate on bone metabolism markers in patients with rheumatoid arthritis

The aim of the present study was to evaluate the influence on urinary excretion levels of N-telopeptide of type I collagen (NTX) and deoxypyridinoline (DPD) as a useful marker for bone resorption, and on serum-bone alkaline phosphate (BAP) levels as a useful marker for bone formation and an early marker of osteoblast differentiation in patients with rheumatoid arthritis (RA) treated with methotrexate (MTX). Thirty patients with RA, diagnosed according to the criteria of the American College of Rheumatology, were involved in this study between March 2003 and January 2005. None of the patients had a history of hormone (estrogen) replacement therapy. All patients were treated with MTX. Methotrexate was administered perorally at a dosage of 4-10 mg/week. All patients underwent general and physical examinations and routine blood and urinary analysis at the baseline, 3 months and 6 months after the initial treatment. Then the levels of NTX and DPD in urine and BAP in serum were measured in all patients. For comparison with the effect of other DMARDs on bone metabolism markers in RA patients, we measured the levels of NTX and DPD in urine and BAP in serum of RA patients, 13 patients treated with salazosulfapyridine (SASP), and 14 patients treated with actarit (ACT). In patients treated with MTX, NTX levels decreased significantly at 3 months after the initial treatment and remained low at 6 months after the initial treatment, and DPD levels significantly decreased at 6 months after the initial treatment. The mean serum BAP levels changed without significant differences from the baseline at 3 months and 6 months. In patients treated with SASP and ACT, all bone metabolism markers had not changed significantly at the three time points. On disease activity erythrocyte sedimentation rate, C-reactive protein, the number of swollen joints and tender joints, and mHAQ score decreased significantly at 3 months after the initial treatment, and remained at low levels at 6 months after the initial treatment with MTX. Methotrexate therapy looks promising in inhibiting generalized bone loss in patients with RA. In addition, NTX is a more sensitive marker than DPD.

The effect of infliximab on chemokines in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease characterized by infiltration of lymphocytes, macrophages, and plasma cells into synovial membrane. The chemokines family promotes chemotactic activity in various leukocyte cell types. Chemokines thus play an essential role in the pathological formation of RA. The aim of the present study was to evaluate the influence of infliximab on serum levels of various chemokines. Twenty-four RA patients were involved in this study, which took place between March 2003 and February 2006. Infliximab was administered by intravenous infusion at a dosage of 3 mg/kg. All patients underwent general and physical examinations and routine blood and urinary analysis at the baseline, at 14 weeks, and at 30 weeks after the initial treatment. To determine whether serum and synovial fluid from RA also contained significant levels of chemokines compared with osteoarthritis patients (OA), GRO-alpha, MIP-1alpha, MIP-1beta and regulated on activation normal T cell expressed and secreted (RANTES) levels of serum and synovial fluid were measured by ELISA in 20 RA patients and 20 OA patients. GRO-alpha, MIP-1beta, and RANTES levels were significantly higher in RA compared with normal volunteers, while MIP-1alpha levels showed no significant differences. The mean GRO-alpha levels in serum from RA patients treated with infliximab decreased significantly after the initial treatment. The mean RANTES and MIP-1beta levels did not change significantly after the treatment. Infliximab treatment significantly lowered the serum GRO-alpha levels of RA patients. GRO-alpha is one of the crucial cytokines affected by infliximab treatment. The blocking therapy of RANTES and MIP-1beta combined with infliximab treatment may have an additional effect without competition in the TNFalpha cascade.

Anti-tumor necrosis factor-alpha antibody treatment reduces serum CXCL16 levels in patients with rheumatoid arthritis

The aim of this study was to analyze the change of serum chemokins levels of CXCL16, CX3CL1/Fractalkine, and CXCL10/interferon-gamma inducible protein-10 (IP-10) with rheumatoid arthritis (RA), by infliximab treatment. The effects of infliximab treatment were studied in 23 patients with RA, over a period of 30 weeks. The serum levels of CXCL16, Fractalkine, and IP-10, were measured at the baseline, just before initial treatment, and at 14 and 30 weeks after the initial treatment, with infliximab by ELISA. The higher levels of serum CXCL16 in the RA patients before treatment with infliximab significantly decreased at 14 and 30 weeks after the initial treatment with infliximab, but the serum Fractalkine and IP-10 levels did not decrease significantly. Infliximab treatment significantly lowered the serum levels of CXCL16 in patients with RA. CXCL16 is one of the crucial chemokines regulated by infliximab treatment.

Treatment with anti-TNF-α antibody infliximab reduces serum IL-15 levels in patients with rheumatoid arthritis

The aim of this study was to analyze the change of serum cytokines and pentosidine levels in patients with rheumatoid arthritis (RA) by infliximab treatment. Twenty-three patients with RA were studied for 30 weeks on the effects of infliximab treatment. Serum levels of IL-15, IL-16, IL-17, and granulocyte-macrophage colony-stimulating factor (GM-CSF) were measured with ELISA methods and pentosidine levels were determined using high-performance liquid chromatography, both at baseline and at 14 and 30 weeks after the initial treatment with infliximab. In addition, the patients also underwent physical and routine blood examinations. The higher levels of serum IL-15 in RA patients before treatment with infliximab significantly decreased at 14 and 30 weeks after the initial treatment with infliximab, but serum IL-16, IL-17, GM-CSF, and pentosidine levels did not decrease. The serum IL-17 and GM-CSF levels remained to be a limited detectable level at the pre- and posttreatment with infliximab. Infliximab treatment significantly lowered the serum levels of IL-15 in patients with RA. IL-15 is one of the crucial cytokines affected by infliximab.

The occurrence of a geode in the olecranon of a patient with rheumatoid arthritis

Geode, a subchondral cyst, is sometimes seen in the femur, knee, or wrist in a patient with rheumatoid arthritis (RA). But the onset of a giant geode at the olecranon is extremely rare in a patient with RA. We describe herein a rare case of a giant geode at the olecranon in a patient with RA.

The effect of infliximab on bone metabolism markers in patients with rheumatoid arthritis

OBJECTIVE

The aim of this study was to evaluate urinary excretion of N-telopeptide of type I collagen (NTX) and deoxypyridinoline (DPD), markers of bone resorption, and serum bone alkaline phosphatase (BAP) level, a marker of bone formation and an early marker of osteoblast differentiation, in patients with rheumatoid arthritis (RA) treated with infliximab.

METHODS

Seventeen male and female patients (age 60.7+/-2.53 yr; mean disease duration 12.9+/-3.01 yr; Steinbrocker's class II-IV) with RA, diagnosed according to the criteria of the American College of Rheumatology (ACR), took part in the study between March 2003 and January 2005. None of the patients had a history of oestrogen replacement therapy. All patients were treated with infliximab combined with methotrexate. Infliximab was infused intravenously at 3 mg/kg at baseline, 2 and 6 weeks, then every 8 weeks. To evaluate disease activity, ESR, CRP, the numbers of swollen and tender joints, modified Stanford Health Assessment Questionnaire (mHAQ) score and ACR score were measured. Levels of NTX and DPD in urine and BAP in serum were measured in all patients.

RESULTS

ESR, CRP, the number of swollen joints and tender joints, and mHAQ score had decreased significantly 6 weeks after initial treatment and were still low 6 months after initial treatment. NTX levels had decreased significantly 6 weeks after the initial treatment and were still low 6 months after initial treatment. DPD levels had decreased 6 months after initial infusion. Mean serum BAP level did not differ significantly among the three time points. NTX levels were statistically corresponding with the number of swollen joints and mHAQ scores. DPD levels were statistically lower corresponding with ESR.

CONCLUSION

Infliximab therapy may inhibit generalized bone loss in patients with RA. NTX is a more sensitive marker than DPD.

Soft x-ray absorption spectra of ilmenite family

We have carried out soft x-ray absorption spectroscopy to study the electronic structure of ilmenite family, such as MnTiO3, FeTiO3, and CoTiO3 at the soft x-ray beamline, BL23SU, at the SPring-8. The Ti and M L2,3 absorption spectra of MTiO3 (M=Mn, Fe, and Co) show spectra of Ti4+ and M2+ electron configurations, respectively. Except the Fe L2,3 spectrum, those spectra were understood within the O(h) symmetry around the transition metal ions. The Fe L3-edge spectrum clearly shows a doublet peak at the L3 edge, which is attributed to Fe2+ state, moreover the very high-resolution the L-edge spectra of transition metals show fine structures. The spectra of those ilmenites are compared.