Background/Purpose: The goal of therapy of rheumatoid arthritis(RA) is to achieve a remission or at least low disease activity. Tocilizumab completely interrupt the effect of IL-6 and showed a full inhibition of CRP production¹. So we are interested in whether it will influence the outcome measure to predict RAactivity in daily practice.This study aimed to investigate whether RA patients on tocilizumab therapy had the same efficacy on ultrasound and inflammatory parameters as compared with adalimumab treatment.

Methods: We compared RA patients on tocilizumab and adalimumab therapy and evaluated inflammatory parameters and ultrasound score. Gray scale synovial hypertrophy (SH) and power Doppler (PD) ultrasound were performed on bilateral dorsal radio-carpal joints of in patient. The sum of the score was calculated.Independent t test was used to compare inflammatory mediators and ultrasound scores between tocilizumab and adalimumab.

Results: A total of 48 patients with RA (24 tocilizumab and 24 adalimumab) were enrolled. The age, gender, rheumatoid factors and ACCP were no difference between these two groups. The mean ultrasound was 2.33±1.40 (Tocilizumab) and 2.08±1.53 (Adalimumab), p=0. 570. The ESR , CRP and DAS 28 were lower at Tocilizumab group. (Table 1)

Conclusion: From this study, in patients on tocilizumab therapy, the laboratory parameter and clinical evaluation was lower than adalimab depite the same ultrasound score beteen the two group. So we cannot measure disease activity based only on clinical evaluation. We suggest using PD ultrasound evaluation in all the patients on tocilizumab therapy to actually reflect the true nature of disease entity in these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-is-more-reliable-than-inflammatory-parameters-esr-and-crp-to-evaluate-disease-activity-in-rheumatoid-arthritis-patients-on-tocilizumab-therapy/