ANA Indicative of Poor Response to bDMARDs in RA

Development of antinuclear antibodies (ANA) could indicate poor response in patients with rheumatoid arthritis (RA) undergoing treatment with biological disease-modifying antirheumatic drugs (bDMARDs), according to a study published in Seminars in Arthritis and Rheumatism.

In this prospective single-center cohort study, patients with RA were recruited to determine associations between treatment response and ANA development, during treatment with bDMARDs (n=657) or without bDMARDs (n=211). Infliximab (IFX), etanercept, adalimumab, golimumab, certolizumab-pegol, tocilizumab (TCZ), and abatacept (ABT) were included as the bDMARDs evaluated. Investigators requested routine serial ANA profiles every 3 months along with treatment histories and clinical data. ANA levels of more than 1:80 were considered positive; development of ANA was defined as >2 times that of baseline values. Statistical analysis was performed to determine the correlation between the variables and insufficient response to bDMARDs, baseline ANA levels, or ANA development.

Related Articles

ANA development within a year of bDMARDs treatment was significantly associated with insufficient response (odds ratio [OR], 2.68; 95% CI, 1.55-4.65; P =.00044). When analyzed at 3 months and 12 months, investigators found that ANA development at 3 months was significantly associated with insufficient response (OR, 3.51; 95% CI, 1.21-10.2; P =.02). Patients who did develop ANA within a year but not at 3 months demonstrated a significant association with treatment failure between 12 and 24 months (OR, 3.16; 95% CI, 1.06-9.39; P =.0038). Upon deeper analysis, the use of TNF-α inhibitors (TNFi), especially IFX, was revealed to be a significant risk for ANA development within a year. Non-TNFi bDMARDs (TCZ and ABT) were not associated with ANA development.

This study was potentially limited by its design which involved only a single center cohort of Japanese patients with RA.

These findings indicate that there is a strong association between ANA development during bDMARDs treatment and poor future treatment outcomes. In patients with RA who are being treated with bDMARDs, clinical monitoring of ANA could be a predictive tool for later poor treatment outcomes.


Ishikawa Y, Hashimoto M, Ito H, et al. Anti-nuclear antibody development is associated with poor treatment response to biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis [published online Feb 10, 2019]. Semin Arthritis Rheum. doi: 10.1016/j.semarthrit.2019.02.003