Indicators In Rheumatoid Arthritis With The Treatment Of Adalimumab

Backgroud:Rheumatoid arthritis(RA) is a chronic systemic autoimmune disease with the feature of synovitis.Showed as chronic progressive erosion inflammation of the peripheral joint,and ultimately teratogenic disabled.In recent years,a breakthrough in the pathogenesis,diagnosis and treatment of RA has been made,but the cause has not yet entirely clear.The mechanisms of articular cartilage,bone destruction in RA and the basis of cellular and molecular are still the focus of research.The research of corresponding effective treatment for prevention of disability is the focus and purpose currently.In recent years,many scholars at home and abroad dedicated to pathogenesis and early diagnosis of RA,great progress has been made,but the exact etiology and pathogenesis remains unclear.After many studies,researchers has found a number of specific antibodies in the serum of RA patients for the diagnosis.From the 1987,rheumatoid factor (RF) was included in the classification of diagnostic criteria by ACR,and in 2009,the serum anti-cyclic citrullinated Peptide (CCP) antibodies was included into the classification of diagnostic criteria by EULAR for the first time. Overseas studies have shown that anti-CCP antibodies can appear in the serum of RA patients earlier than the clinical manifestations for 3 years averagely,so that the anti-CCP antibodies was included into the classification of diagnostic criteria achieve a major step forward for early diagnosis of RA.However,the sensitivity of anti-CCP antibodies is only around 70%, therefore,many domestic and foreign scholars are still trying to find more specific indicators in serum for helping in the early diagnosis of RA.The anti-citrullinated vimentin mutant (MCV) antibody,S100 protein family are more popular in recent years.And related studies have shown the both titer in the serum was associated with RA disease.Since the high disability of RA,early diagnosis and early effective treatment is particularly important.With the continuous improvement of the detection means,early diagnosis has become possible,but also a breakthrough treatment for RA patients has opened up broad prospects.In recent years,a variety of TNF-αantagonists in treatment of RA are all listed,and ATTRACT,TEMPO,BeST and many other large sample randomized,double-blind clinical studies showed that TNF-αantagonists are safety,well tolerated,and significant improvement in RA symptoms,signs and indicators of inflammation,while inhibition of structural damage(bone erosion and joint space narrowing),and reduce the incidence of disability.This gives patients a new treatment and bring the gospel.Some scholars have suggested that a high degree of activity in the disease and indications of poor prognosis in early RA patients,TNF-αantagonists should be used.But the high cost of treatment,and clinical observation showed that about 30% of patients receiving this expensive therapy are ineffective.There are lack of some indicators of adequate evidence to predict the effect of TNF-αantagonists in clinical.Objective:Evaluate the effect of adalimumab (a fully human anti-TNF-αmonoclonal antibody) in the active RA.To probe the impact of adalimumab on anti-CCP antibodies,anti-MCV antibodies,S100A8/A9 complex in the serum of RA.To probe the relationship between the efficacy of adalimumab in RA patients and the levels of anti-CCP antibodies,anti-MCV antibodies,S100A8/A9 complex at the baseline.At the same time,to find out the relationship between anti-CCP antibodies,anti-MCV antibodies and S100A8/A9 complex,evaluating the advantages and disadvantages of the three indicators in monitoring RA.Methods:40 cases of active RA patients(They are all meet with 1987 American College of Rheumatology RA classification criteria)in our hospital outpatient and inpatient during the September 2007 to September 2008 were randomly assigned to treatment group and control group.32 patients were involved in treatment group and the other 8 patients were involved in control group.Collecting the baseline data of the patients,including demographic information;clinical data:the number of tender and swollen joints,morning stiffness,visual analogue scale(VAS score),Health Assessment Questionnaire(HAQ);Laboratory information:CRP.Serum was collected at baseline and stored at -80℃.Patients included received the treatment of adalimumab+MTX or MTX for 12 weeks.Detect the levels of anti-CCP antibodies,anti-MCV antibodies and S100A8/A9 complex in serum at baseline at the end of treatment.Assess the efficacy of adalimumab in RA.The patients were divided into two groups according to efficacy,and statisticing the differences of serum markers before and after treatment.Statistic the differences of anti-CCP antibodies,anti-MCV antibodies and S100A8/A9 complex at the baseline between different efficacy groups,and to discuss the relationship between anti-CCP antibodies,anti-MCV antibodies and S100A8/A9 in the serum of RA.Results:In treatment group,22 patients in 32 achieved to ACR20,the effective rate is 68.8%;17 patients achieved to ACR50,the effective rate is 53.1%;12 patients achieved to ACR70,the effective rate is 37.5%;and 7 patients achieved to the clinical remission criteria,the effective rate is 21.9%;significantly higher than the control group(P<0.01). The treatment group was divided into two groups according to different efficacy criteria,the levels of anti-MCV antibodies had no significant difference between before and after treatment at the group that do not meet ACR20(P>0.05),and the levels of anti-CCP antibodies and anti-MCV antibodies had significant difference between before and after treatment at the other groups(P<0.05).After treatment,the titer of the anti-CCP antibodies and anti-MCV antibodies had decreased.And we had not observed the similar changes at the control group.Before and after treatment in any group,the differences of S100A8/A9 complex were not statistically significant (P>0.05).The differences of the levels of anti-CCP antibodies,anti-MCV antibodies and S100A8/A9 were not statistically different at the baseline between the groups that met ACR20,ACR50,ACR70,clinical remission criteria and the groups that did not met ACR20,ACR50,ACR70,clinical remission criteria(P>0.05).The titers of anti-CCP antibodies and anti-MCV antibodies were positively correlated before treatment(P<0.05).And they were not correlated after treatment(P>0.05).The levels of anti-CCP antibodies and S100A8/A9 complex were not correlated either before or after treatment(P>0.05).The levels of anti-MCV antibodies and S100A8/A9 complex were positively correlated either before or after treatment(P>0.05).Conclusions:1.Treatment with adalimumab can reduced the activity of RA.2.Adalimumab can reduce the levels of anti-CCP antibodies and anti-MCV antibodies in the serum of RA,but it can not reduce the level of S100A8/A9 complex.3.Anti-CCP antibodies and anti-MCV antibodies may have their own strengths in the monitoring of RA.4.According to the results of this experiment,the level of anti-CCP antibodies,anti-MCV antibodies and S100A8/A9 complex did not predict the effect of adalimumab in RA.5.The relationships of different cytokines in RA were complicated,and they can not been clarified according to a single factor.6.Anti-CCP antibodies and anti-MCV antibodies has certain complementary in the diagnosis of RA.