Anti-TNF Therapy Reduces Glycosaminoglycan Levels in Women With RA

Despite the extensive body of literature on rheumatoid arthritis (RA), the exact causes of the disease are not fully understood. Tumor necrosis factor alpha (TNF) is known to play a key role in the disease by stimulating catabolic processes and causing inflammation, and important elements of inflammation include changes in extracellular matrix compounds and their constituents, such as glycosaminoglycans (GAGs). GAGs are thought to play a role in RA pathogenesis; a recent study sought to describe the impact of anti-TNF agents on GAG levels in women patients with RA.

A total of 45 female patients who had an inadequate response to at least 2 disease-modifying anti-rheumatic drugs were recruited for the study; 22 received adalimumab, 19 received etanercept, and 4 received certolizumab pegol. All patients continued to take methotrexate and prednisone. Twenty age-matched volunteers were included as controls.

Sixteen patients were excluded from the study due to lack of efficacy, loss of response, withdrawal of consent, intolerance, or surgical procedures. The remaining 29 patients, all of whom responded well to biologic treatment, completed 15 months of therapy. A total of 38% achieved remission at month 9, and 80% achieved remission at month 15. The remaining patients had low disease activity.

In these patients, at 3 months, a statistically significant decrease in total GAG level was observed, and GAG levels continued to drop with therapy until levels matched those of the controls.

“To the best of our knowledge, this is the first study that reports an association between good clinical response to anti-TNF treatments and the plasma GAGs in RA patients,” write the authors, adding that the reduced GAG levels may be due to reduced enzymatic a nonenzymatic catabolic processes as a result of therapy.

The authors concluded that anti-TNF therapy in women patients with RA has a beneficial effect on metabolism of tissue GAGs, and that normalization of plasma levels of GAGs suggests improvement in the extracellular matrix remodeling balance.

Reference

Szeremeta A, Jura-Półtorak A, Koźma EM. Effects of a 15-month anti-TNF-a treatment on plasma levels of glycosaminoglycans in women with rheumatoid arthritis. Arthritis Res Ther. 2018;20: 211. doi: 10.1186/s13075-018-1711-z.