One of the most important methods to assess the efficacy of anti-rheumatic drug is radiological assessment by van der Heijde modified Sharp score (vdH-Sharp score). Now there is a large body of evidence that anti-TNF agents block bone resorption in US and Europe but not in Japan. We have investigated infliximab can prevent structural damage in our 46 Japanese RA patients. The average yearly progression of vdH-Sharp score of 46 patients before starting infliximab was 32±34, whereas the average increase of vdH-Sharp score one year after infliximab was significantly low as 4±10.The yearly progression of vdH-Sharp score was related with neither disease activity markers (DAS28-CRP, CRP, MMP-3) at introduction of infliximab nor the average of those checked at 9 visits during one-year infliximab therapy.
These results showed infliximab actually prevented structural damage in Japanese RA patients, and the inhibitory effect of infliximab on radiological progression was not related with disease activity as previously reported. These findings suggest that TNF may have a direct effect on bone remodeling machinery not via inflammatory process. Anti-TNF therapy may abolish arthritic bone erosion and prevent joint deformity, which will serve better quality of life for RA patients.
