ANTI - TUMOR NECROSIS FACTOR ALPHA (ANTI-TNF) DRUGS IN RHEUMATOID ARTHRITIS: COMPARISON ON DISEASE MANAGEMENT BEFORE AND AFTER THE INTRODUCTION OF THESE BIOLOGICAL DRUGS IN MODENA, ITALY

Background: Anti-Tumor Necrosis Factor alpha (anti-TNF) drugs markedly improved the therapeutic approach to Rheumatoid Arthritis (RA) and consequently the quality of life of these patients.Objectives: Aim of the present study was to compare the disease progression in RA patients treated before and after 2000, when anti-TNF drugs were introduced in our Rheumatology Unit.Methods: We currently follow a standardized protocol; namely, at our RA clinic all patients were carefully monitored with clinico-serological evaluation every 3 months; only patients with DAS-28 > 5.1, unresponsive to standard treatments, are treated with anti-TNF drugs. A study was performed in 2000 on 100 consecutive patients (F 81/M 19) with RA that came to the attention of our Department and was repeated in 2007 (F 82/M 18). All patients were evaluated by Disease Activity Score (DAS-28) and by Health Assessment Questionnaire (HAQ), both tests internationally accepted.Results: Patients in the first group (year 2000) had an average age of 63.5, disease presence for 14.3 years on average, DAS-28 of 4.47±0.98, HAQ of 1.5±0.7. Only 2 patients showed a DAS-28 lower than 2.6 whereas 25 patients had a DAS-28 higher than 5.1. These data are substantially similar to those emerging from a similar study published by Pincus (1), based on American population in the same years (paper published in 2007 but referred to a comparison between patients with RA followed in the United States in 1985 and in 2000). Patients in the second group (year 2006) had an average age of 60, disease presence for 13.1 years on average, DAS-28 of 3.45±1.1, HAQ of 1.09±0.7 DAS-28 was lower than 2.6 in 27 patients (9 of them on treatment with anti-TNF) DAS-28 was higher than 5.1 in 11 patients (2 of them on treatment with anti-TNF).No statistical differences, with regard to DAS-28 or HAQ, was uncovered among patients of the second group treated with standard treatments or on therapy with anti-TNFdrugs.Conversely first and second group showed a statistically significant difference for both DAS-28 index and HAQ index (p <0,001).Conclusion: These data clearly show that in 2000 disease progression was significantly worse than in 2007. A close and careful follow-up of the disease and the inclusion in a biological-drug therapy protocol with anti-TNF drugs only when necessary (DAS-28 > 5.1) improves disease activity and quality of life; this approach has enabled a better management of RA, bringing from 2% of 2000 to 27% of 2007 the cases in which the disease can be considered in remission (DAS-28 < 2.6).