Rapid and deep control of inflammation in rheumatoid arthritis with infliximab and its correlation with acute-phase reactants.

Rheumatoid arthritis (RA) is a chronic inflammatory disease with predominant joint involvement and possible systemic compromise, which leads to a handicapped status and poor quality of life. An optimal approach to treat RA requires early and intensive intervention with close monitoring of treatment response. Tumor necrosis factor (TNF) blockers are recommended in cases of active RA after the unsuccessful use of effective disease-modifying antirheumatic drugs (DMARDs); even adding them to treatment or replacing these drugs. Anti-TNF therapies have been demonstrated to reduce significant joint damage and to relieve symptoms during a prolonged time (see Scott and Kingsley, 2006). The efficacy of infliximab in an open-label trial is summarized with respect to speed of onset of action, durability of response, and its correlation between clinical and laboratory parameters. Safety for long-term treatment is also summarized. We studied 105 RA patients with more than 3 years' history of disease during 24 months on i.v. infliximab (75 completed study). We evaluated ACR responses at base line, and at 1, 6, 12, 16, 52, 77, and 104 weeks. Morning stiffness, swollen and tender joints, HAQ, SF-36% (PCS/MCS), polymerase chain reaction (PCR), erythrosedimentation rate (ESR), transaminases, rheumatoid factor (RF) levels, hemogram, and adverse events profile were all assessed. The treatment offered rapid and sustained clinical improvements as revealed by ACR responses and marked changes in the parameters previously described. Important changes were made in functional status and acute-phase reactants. Finally, infliximab was considered well tolerated and did not affect the safety profile of this trial.

Open-label 24-month study evaluating infliximab therapy in patients with psoriatic spondyloarthropathy.

Psoriatic spondyloarthropathy (PsSA) is a common and relatively typical form of spondyloarthropathy, affecting the axial skeleton with peripheral synovitis. Also, extraarticular as well as skin manifestations are sometimes difficult to diagnose and to treat. Recent studies demonstrated that anti-tumor necrosis factor therapies are useful in treating and controlling disease activity. We conducted an open-label 2-year study in 16 patients to evaluate the efficacy and safety of long-term compliance with intravenous infliximab therapy in patients with severe skin and refractory PsSA, with an incomplete response to methotrexate, azathioprine, cyclosporine, and/or sulfasalazine. Patients continued to receive only weekly methotrexate therapy during the study that included 16 patients (9 men, 7 women; mean age 38 +/- 12.5 years [SD]) with psoriatic spondyloarthropathy for 16.4 +/- 9.2 years. Each patient underwent complete physical examination before treatment and at each visit until the end of the study. Results of patient global pain assessment (VAS scale), investigator opinion on global assessment of disease activity (100 mm VAS), patient body weight and blood pressure, ACR response (20%, 50%, and 70%), laboratory parameters (CRP, ESR, WBC, RBC, liver enzymes, etc.), and PASI (skin score) were recorded. We conclude that infliximab therapy was effective in controlling joint and skin disease, having an acceptable safety profile and very good compliance when considering this type of patient. However, further long-term, double-blind, placebo-controlled trials are necessary to validate these results.