TNF-α Inhibitor Therapy May Benefit Extracellular Matrix Remodeling in Women With RA

deformed woman's hands from rheumatoid arthritis
deformed woman’s hands from rheumatoid arthritis
Anti-TNF-α therapy has a beneficial effect on the metabolism of proteoglycans and glycosaminoglycans tissue in women with rheumatoid arthritis.

The use of anti-tumor necrosis factor-alpha (TNF-α) has a beneficial effect on metabolism of proteoglycans (PGs) and glycosaminoglycans (GAGs) tissue in women with rheumatoid arthritis (RA), according to the results of a study published in Arthritis Research & Therapy.

The investigators sought to evaluate the effects of 15-month anti-TNF-α therapy on circulated levels of plasma sulfated GAGs, the sugar constituents of PGs, and the nonsulfated GAG hyaluronic acid in women with RA. Plasma levels of keratin sulfate and hyaluronic acid were measured using immunoassays. Total sulfated GAGs were computed with using a hexuronic acid assay.

A total of 45 women with RA (mean age, 47.42±13.70 years) were recruited for this study, along with 20 age-matched healthy female volunteers. The effectiveness of TNF-α antagonist treatment was assessed at baseline and then at 3, 9, and 15 months after the initiation of therapy, using the 28-joint Disease Activity Score indicator. Participants were treated with etanercept, adalimumab, or certolizumab pegol in combination with methotrexate.

Total sulfated GAGs and hyaluronic acid levels were significantly higher among women with RA before treatment compared with healthy control patients (P <.001 for both). No difference in keratin sulfate levels was observed between women with RA and control patients. The use of anti-TNF-α therapy was associated with normalization of plasma total GAG and hyaluronic acid levels in women with RA, with no effect on keratin sulfate levels. The quantitative changes in plasma GAG levels seen during biologic therapy appear to be the result of an effective inhibition of the pro-inflammatory cytokine TNF-α, rather than from the direct effect of anti-TNF-α treatment tissue extracellular matrix remodeling.

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The investigators concluded that the use of anti-TNF-α treatment has a beneficial effect on extracellular matrix remodeling in the course of RA. The observations from this study offer a further mechanism for clarifying the cartilage-protective effects of TNF-α inhibitors on tissue extracellular matrix remodeling.

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Szeremeta A, Jura-Półtorak A, Koźma EM, et al. Effects of a 15-month anti-TNF-α treatment on plasma levels of glycosaminoglycans in women with rheumatoid arthritis. Arthritis Res Ther. 2018;20(1):211.