Identifying rheumatoid arthritis patients that are suitable for a lower dose of anti-TNF alpha therapy

This study examined whether a combination of clinical and ultrasound assessments could identify rheumatoid arthritis patients suitable for a lower dose of anti-TNF alpha therapy. 

Anti-TNF alpha therapy (Humira, Enbrel, Remicade and Cimzia) is used to treat patients who have a severe form of rheumatoid arthritis (RA). Patients can enter remission (no signs or symptoms of disease) when taking anti-TNF alpha therapy. Patients must take anti-TNF alpha therapy continuously as stopping it can result in relapse (return of signs and symptoms).

Anti-TNF alpha therapy is considered to be an aggressive form of therapy. In rheumatoid arthritis, the immune system (the body’s defense against disease) attacks healthy joints. In order to reduce the symptoms of RA, anti-TNF alpha therapy reduces the function of the immune system. This leaves patients susceptible to infections and possible cancers.

It may be possible to reduce the dose in patients who are in remission or have low disease activity in order to reduce the side effects. Clinical measures are used to determine whether a patient is in remission. These include examining the joints for pain and swelling. Clinical measures, though, could miss internal joint damage. Ultrasound could measure continuing internal joint damage. Using both clinical measures and ultrasound imaging may help to identify patients that are in remission.

This study aimed to determine whether combining clinical and ultrasound assessments could identify patients in remission who could reduce their dose of anti-TNF alpha therapy. This study involved 70 patients with severe RA. Once in remission, participants reduced the anti-TNF alpha therapy by one third. Clinical assessment and ultrasound of the hands and wrist were used to determine whether remission was maintained.

96% maintained remission after 3 months and 34% after 18 months. 88% of patients maintained at least low disease activity at 6 months. Patients remaining in remission were more likely to be negative for rheumatoid factor (the antibody that causes the immune system to attack healthy joints).

This study concluded that clinical and ultrasound assessments can identify patients in remission that are suitable for a lower dose of anti-TNF alpha therapy.

The number of patients in remission may have been underestimated. This is due to the fact that factors which influence the detection of inflammation in the joints were not accounted for.

Consult your physician regarding your suitability for a reduction in the dose of anti-TNF alpha therapy.