Change of serum Amyloid a predict The Effect Of Biological Treatment In Rheumatoid Arthritis Patient

Chisa Okura¹, Yukio Yonemoto², Koichi Okamura¹, Tetsuya Kaneko³, Tsutomu Kobayashi¹ and Kenji Takagishi¹, ¹Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan, ²Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan, ³Department of Orthopaedic Surgery, Inoue Hospital, Takasaki, Gunma, Japan

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Amyloidosis, biologic response modifiers, prognostic factors, rheumatoid arthritis (RA) and tocilizumab

Session Information

Title: Rheumatoid Arthritis Treatment - Small Molecules, Biologics and Gene Therapy III

Session Type: Abstract Submissions (ACR)

Background/Purpose: The C-reactive protein (CRP) level and the erythrocyte sedimentation rate (ESR) are common markers of inflammation in patients with rheumatoid arthritis (RA). The serum amyloid A (SAA) level is also a sensitive inflammatory marker, and biologic medications, especially tocilizumab (TCZ), an inhibitor of IL-6,have been reported to decrease the SAA levels. However, thus far, few reports have compared the SAA level, disease activity, other inflammatory markers and future outcomes following treatment with biologics.The aim of this study was to assess the SAA level, the levels of other inflammatory markers and the disease
activity in patients with RA who are receiving biologics.

Methods: The subjects included 32 RA patients who started to receive biologic treatment in or after July 2008 (17 patients received TNF inhibitors and 15 patients received TCZ). The swollen joint count, the tender joint count, the DAS28-ESR score and the levels of SAA, ESR, CRP and MMP-3 were assessed before treatment and at two, four and six months after treatment.

Results: No significant differences were found among the groups at baseline. At two, four and six months after treatment, the SAA, ESR and CRP levels in the TCZ group were significantly lower than those in the TNF inhibitor group.The DAS28-ESR scores obtained six months after treatment were significantly correlated with the SAA, ESR and CRP levels obtained two and four months after treatment in the TNF inhibitor group and with only the SAA levels obtained two and four months after treatment in the TCZ group.

Conclusion: We used the DAS28-ESR score as an endpoint in this study. It has been reported that comparatively high values may be obtained for both efficacy and remission rates, particularly in patients treated with TCZ, which directly inhibits inflammatory responses. Furthermore, there are also reports of relationships having been found between the DAS28-ESR and the CDAI and SDAI, thus indicating that DAS28 assessments are sufficiently useful.In our study, the DAS28-ESR scores obtained six months after treatment significantly correlated with only the SAA levels obtained after two and four months in the TCZ group. These results suggest that it may be possible to use the SAA level as a predictive factor of the therapeutic effects for not only TNF inhibitor therapy, but also for TCZ therapy.

Disclosure:

C. Okura,
None;

Y. Yonemoto,
None;

K. Okamura,
None;

T. Kaneko,
None;

T. Kobayashi,
None;

K. Takagishi,
None.

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