Response to Tumor Necrosis Factor Inhibitors in Rheumatoid Arthritis for Function and Pain is Affected by Rheumatoid Factor



Babak Aberumand 1, §, Lillian Barra 1, Yang Cao 1, §, Nicole Le Riche 1, Andrew E Thompson , Gina Rohekar 1, Sherry Rohekar 1, Ashley Bonner 1, Janet E Pope*, 1
1 Schulich School of Medicine & Dentistry, University of Western Ontario, Department of Medicine, Division of Rheumatology, St. Joseph’s Health Care, Ontario, Canada
2 McMaster University, Hamilton, ON, Canada


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© Aberumand et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the St. Joseph’s Health Care, 268 Grosvenor St., London, ON, N6A 4V2, Canada; Tel: 519-646-6332; Fax: 519-646-6334; E-mail: janet.pope@sjhc.london.on.ca
§ Babak Aberumand and Yang Cao are Canadian Rheumatology (CRA) Roche Research Summer Students.


Abstract

Objectives :

To investigate differences in response to tumor necrosis factor inhibitor treatment (TNFi) in seropositive (rheumatoid factor positive; RF+) versus seronegative (RF-) patients with established RA as measured by the Health Assessment Questionnaire Disability Index (HAQ-DI) and pain.

Methods :

RA patients from an established RA cohort were studied according to rheumatoid factor (RF) status for change in HAQ-DI and pain (0-3 VAS) one year after starting treatment with a TNFi.

Results :

There were 238 patients treated with TNFi who had follow-up data (178 RF+ and 60 RF-). Disease duration was longer in RF+ vs RF- (12+8 vs 8+8 years) but the proportion of females (82% vs 72%, P=0.7), baseline HAQ-DI (1.44+0.63 vs 1.41+0.63, P=0.8) and pain (1.92+0.67 vs 1.93+0.67, P=0.9) were not different. The mean duration of treatment of first TNFi was 2.8 vs 2.3 years, P=0.1 and 68% of RF+ vs 62% of RF- were still receiving first TNFi at last visit (P=0.5). For patients with data at baseline and one year, the one-year HAQ-DI change was significantly greater in 90 RF+ patients (-0.356) versus 38 RF- patients (-0.126; P=0.04). The mean pain improvement was also greater in 77 RF+ vs 32 RF- patients (-0.725 vs -0.332 respectively; P=0.03). Numbers are small, data are missing and comorbidities, DAS28 and anti-CCP were not collected.

Conclusion :

Despite limitations in the data, in established RA after failure of DMARDs, RF+ patients may be more responsive to TNFi therapy as measured by changes in HAQ-DI and pain.

Innovation :

There may be a better response to TNFi in RA if RF positive for function and pain.

Keywords: Adalimumab, etanercept, health assessment questionnaire disability index (HAQ-DI), infliximab, pain, response, rheumatoid arthritis (RA), rheumatoid factor (RF), tumour necrosis factor inhibitor (TNFi)..