以肌肉骨骼超音波預測類風濕性關節炎病患使用抗腫瘤壞死因子療法的藥物存活

Predicting TNF-αInhibitor Persistence in Rheumatoid Arthritis: The Role of Baseline Characteristics and Musculoskeletal Ultrasound

目的：探討類風濕性關節炎病患使用抗腫瘤壞死因子類生物製劑治療前的肌肉骨骼超音波結果是否與藥物存活有關。
方法：本研究回溯分析第一線開始使用抗腫瘤壞死因子類生物製劑治療且於之前3個月內有接受肌肉骨骼超音波檢查的病人。灰階、都普勒血流影像及合併分數照OMERACT分級評分。後續針對「持續使用」及「停用」抗腫瘤壞死因子類生物製劑治療病人的臨床特性及超音波影像結果做比較。
結果：於2011-2021年間，本院有65位類風濕性關節炎病患在開始使用抗腫瘤壞死因子類生物製劑治療前的3個月內有接受肌肉骨骼超音波檢查。16位(24.6%)在一年內因效果不佳停用或轉換到其他生物製劑。藥物存活與治療前較高的滑液膜發炎呈正相關，與抗環瓜氨酸抗體及屈肌肌腱病變呈現負相關。
結論：即使治療前的肌肉骨骼超音波檢查有較高的滑液膜發炎，類風濕性關節炎病人第一線使用抗腫瘤壞死因子類生物製劑治療仍可能有不錯的藥物存活；抗環瓜氨酸抗體陽性及屈肌肌腱病變則為藥物停用之危險因子。

Objective: To determine the association between musculoskeletal ultrasonography (MSUS) findings prior to initiation of anti-TNF-a therapies / TNF-a inhibitors (TNFi) and the persistence of biological disease modifying anti-rheumatic drug (bDMARD) in patients with rheumatoid arthritis (RA).
Methods: This retrospective study included patients with RA who commenced first-line TNFi and underwent MSUS examination within 3 months preceding treatment initiation. Gray-scale and power- Doppler images were collected, and a combined score was calculated. Differences between patients who continued and discontinued therapy were compared.
Results: A total of 65 patients were recruited from National Taiwan University Hospital during the study period (2011–2021). Sixteen patients (24.6%) discontinued TNFi at the 1-year mark. Retention of TNFi was associated with negative or lower anticyclic citrullinated peptide antibody (ACPA) levels, higher MSUS synovitis scores, and absence of flexor tendinopathy.
Conclusion: In patients with RA, elevated baseline MSUS synovitis was not associated with TNFi treatment discontinuation. Conversely, positive or high-titer ACPA and the presence of flexor tendinopathies were associated with treatment discontinuation.