Background/Purpose: To explore the effects of tofacitinib (Tofa) on US lesions in a consecutive series of patients with active RA MTX and/or bioDMARDs -IR. 

Methods: In this observational, open label, longitudinal, multicenter study, patients received Tofa 5 mg twice daily + MTX + corticosteroids for 24 weeks. All patients underwent clinical, laboratory and US examinations in a standardized manner according to the EULAR guidelines for musculoskeletal US in rheumatology. Inclusion criteria required an OMERACT-EULAR composite US score for grading synovitis of ≥2 in at least two MCPs. US examinations were performed at baseline (T0), 2w (T1), 4w (T2), 12w (T3) and 24w (T4) for bilateral 20 joint sites and bilateral 20 tendon sites. For each patients we obtained two US joint scores (GS score and PD score) summing up the value of a 0-3 semiquantitative scale for each joint and  a cumulative joint score summing up the values of the OMERACT combined joint score. Moreover we calculated two tenosynovitis scores (GS and PD) by summing the 0-3 score for each tendon. US examination were done in each centre, by the same sonographer, with the same US equipment (Esaote My Lab 70 Class, 12–18 MHz transducers) after a reliability test between the sonographers. Sonographers were blinded to clinical evaluations. Clinical and US data obtained at T0, T1, T2, T3 and T4 examinations were compared (T-test for paired samples) and correlated (Spearman’s Rho).

Results: In total, 37 patients were enrolled and completed the 6 month period study (F 30 (81%), mean age : 58.5+12.6y), mean disease duration : 8.4+6.4y, ACPA + : 24 (66%) , baseline DAS28 : 4.8+1.2, HAQ : 1.3+0.7, CRP : 2.25+3.1 mg/dl). Joint (GS, PD and combined-PDUS) and tendon US scores (GS and PD) were significantly reduced as early as T1 examination as well as at T2, T3 and T4 visits as compared to baseline values (p < 0.001 for all comparisons). There was a statistical significant correlation between reduction of  PD and GS teno-score at T1 examination and HAQ improvement at T4 visit (rho 0.607, p < 0.001 and rho 0.408, p = 0.017 respectively). Improvement of joint US scores (GS, PD and PDUS-combined) correlated at T4 examination with the reduction of serum CRP levels (rho 0.418, p = 0.036, rho 0.495, p=0.004 and rho 0.454, p=0.009 respectively). We did not found any correlation between the variations of DAS28 and any US scores at any visits.

Conclusion: These preliminary results provide evidence that Tofa treatment leads to early (two weeks) and persistent reduction of US signs of inflammation both at tendon and joint level.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rapid-effect-of-tofacitinib-in-reducing-us-joint-and-tendon-inflammatory-lesions-of-ra-patients-data-from-a-24-weeks-longitudinal-study/