PATIENTS TREATING WITH RHEUMATOID ARTHRITIS IN ADJARA REGION: WHY BIOLOGICAL THERAPY?
DOI:
https://doi.org/10.52340/jecm.2026.01.05Keywords:
Rheumatoid arthritis, biological therapy, Actemra (Tocilizumab)Abstract
Background. Rheumatoid arthritis (RA) is a chronic systemic inflammatory joint disease of autoimmune origin, affecting approximately 1% of the population. It primarily impacts women aged 30 to 60 and is characterized by progressive cartilage and bone damage, leading to significant disability. While the exact cause is unknown, genetic and environmental factors are implicated. Advances in treatment, particularly with biologic disease-modifying anti-rheumatic drugs (bDMARDs) have improved outcomes, but a cure remains elusive. Tocilizumab, an IL-6 receptor inhibitor, represents a promising biologic therapy for RA, especially for patients unresponsive to conventional synthetic DMARDs (csDMARDs), despite its efficacy, adverse reactions necessitate careful monitoring.
Aim of Study Was to evaluate the efficacy and safety of Actemra (Tocilizumab) managing RA in patients from the Adjara region, aiming to achieve sustained remission or low disease activity while assessing adverse drug reactions.
Materials and Methods. We observed 26 RA patients (22 females, 4 males) aged 28 to 68 years treated with weekly subcutaneous injections of 162 mg Tocilizumab. Clinical parameters, including pain intensity, CRP, and ESR levels, were assessed at 3, 6, and 12 months. Treatment intervals were adjusted based on patient response.
Results. Biologic therapy with Tocilizumab significantly improves patients' conditions by rapidly reducing inflammation, pain, and morning stiffness, enhancing physical function, and lowering long-term complications. CRP and ESR levels drop notably after 3 months and even more after 12 months. After 12 months, most of the patients had light pain intensity and no one had severe pain. After 12 months 27 % of patients had an increased CRP (0% of male, 27% of female), and 73% of patients had normal CRP. After 12 months, just 11% of patients (0% males, 11% females) had high ESR.
Conclusion. Biological treatment demonstrated significant efficacy in reducing inflammation, improving joint function, and achieving sustained remission or low disease activity in RA patients. While adverse events require vigilance, this therapy offers a valuable option for personalized RA management, particularly in cases with poor prognostic factors or csDMARDs failure.
Downloads
References
Tornero Molina, J.; Hernández-Cruz, B.; Corominas, H. Initial Treatment with Biological Therapy in Rheumatoid Arthritis. J. Clin. Med. 2024, 13, 48. https://doi.org/10.3390/jcm13010048
EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann. Rheum. Dis. 2023, 82, 1–3. https://ard.bmj.com/content/82/1/3
New Rheumatoid Arthritis Treatments 2025. https://everyone.org/explore/treatment/?id=37
Brown, P.; Pratt, A.G.; Hyrich, K.L. Therapeutic advances in rheumatoid arthritis. BMJ 2024;384:e070856. https://www.bmj.com/content/384/bmj-2022-070856
Orozco, V.H.A.; Burgos García, M.; Girón, L.N.; Robinson, … Biological therapy in rheumatoid arthritis: A review of adverse reactions. ScienceDirect, 2022. https://www.sciencedirect.com/science/article/abs/pii/S2444440522000681
Fujii, T.; Murata, K.; et al. Management and treatment outcomes of rheumatoid arthritis in the era of biologic and targeted synthetic therapies: evaluation of 10-year data from the KURAMA cohort. Arthritis Res. Ther. 2024, 16. https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03251-z
Fraenkel, L.; Bathon, J.M.; England, B.R.; et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res. 2021. https://doi.org/10.1002/acr.24596
Majorczyk, E.; Mazurek-Mochol, M.; Pawlik, A.; et al. Clinical Factors and the Outcome of Treatment with Methotrexate in Rheumatoid Arthritis. J. Clin. Med. 2022, 11, 6078. https://doi.org/10.3390/jcm11206078
Diep, V.; Barbier, V.; Doussière, M.; et al. Comparison of Rheumatoid Arthritis Patients’ 2-Year Infliximab, Abatacept, and Tocilizumab Persistence Rates. J. Clin. Med. 2022, 11, 5978. https://pubmed.ncbi.nlm.nih.gov/36294300/
González-Álvaro, I.; Ortiz, A.M.; Seoane, I.V.; et al. Biomarkers predicting a need for intensive treatment in patients with early arthritis. Curr Pharm Des. 2015, 21(2), 170–181.
Tsintsadze, N.; Kakhidze, I.; Kakabadze, N.; et al. Treating Ankylosing Spondylitis of Patients in Adjara Region: Why Biological Therapy? J. Clin. Exp. Med. https://journals.4science.ge/index.php/jecm/article/view/3049
Bullock, J.; Rizvi, S.A.A.; Saleh, A.M.; et al. Rheumatoid Arthritis: A Brief Overview of the Treatment. Med Princ Pract. 2018 Sep. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422329/
Interleukin-6 Receptor Inhibitors for the Treatment of Rheumatoid Arthritis. https://www.rheumatologyadvisor.com/cch/role-of-il6-receptor-antagonists-for-ra-management/
D’Angelo, S.; Tirri, E.; Giardino, A.M.; et al. Tocilizumab as Second Anti-TNFα Drug in Patients with Rheumatoid Arthritis, Psoriatic Arthritis and Axial Spondyloarthritis in Italy: GO-BEYOND. J. Clin. Med. 2022, 11, 4178. https://pubmed.ncbi.nlm.nih.gov/35887946/
O’Neil, L.J.; Alpízar-Rodríguez, D.; Deane, K.D. Rheumatoid Arthritis: The Continuum of Disease and Strategies for Prediction, Early Intervention, and Prevention. J. Rheumatol. 2024. https://www.jrheum.org/content/jrheum/early/2024/02/09/jrheum.2023-0334.full.pdf
Molteni, E.; Adinolfi, A.; Bondi, V.; et al. Novel insights into the management of rheumatoid arthritis: one year in review 2024. Clin. Exp. Rheumatol. 2024, 42(5), 947–960. https://pubmed.ncbi.nlm.nih.gov/38743447/
Favalli, E.G.; Maioli, G.; Caporali, R. Biologics or Janus Kinase Inhibitors in Rheumatoid Arthritis Patients Who are Insufficient Responders to Conventional Anti-Rheumatic Drugs. 2024; 84(8), 877–894. https://pubmed.ncbi.nlm.nih.gov/38949688/
Alcaide, L.; Torralba, A.I.; Eusamio Serre, J.; et al. Current state, control, impact and management of rheumatoid arthritis according to patient: AR 2020 national survey. Reumatol. Clin. 2022, 18, 177–183. https://pubmed.ncbi.nlm.nih.gov/33250361/
Leon, L.; Abasolo, L.; Fernandez-Gutierrez, B.; et al. Direct medical costs and their predictors in the EMAR-II cohort: Variability in the management of rheumatoid arthritis and spondyloarthritis in Spain. Reumatol. Clin. 2018, 14, 4–8.
Almutairi, K.B.; Nossent, J.C.; Preen, D.B.; et al. The Prevalence of Rheumatoid Arthritis: A Systematic Review of Population-based Studies. J. Rheumatol. 2021, 48, 669–676.
Smolen, J.S.; Landewé, R.B.M.; et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological DMARDs: 2022 update. Ann. Rheum. Dis. 2023, 82, 3–18.
Smolen, J.S.; Aletaha, D.; et al. Rheumatoid arthritis. Nat. Rev. Dis. Prim. 2018, 4, 18001.
Archer, R.; Hock, E.; Hamilton, J.; et al. Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: Systematic reviews. Health Technol. Assess. 2018, 22, 1–294.
Lewis, M.J.; Barnes, M.R.; Blighe, K.; et al. Molecular portraits of early rheumatoid arthritis identify clinical and treatment response phenotypes. Cell Rep. 2019, 28(9), 2455–2470.e5. https://doi.org/10.1016/j.celrep.2019.07.091
Buch, M.H.; Eyre, S.; McGonagle, D. Persistent inflammatory and non-inflammatory mechanisms in refractory rheumatoid arthritis. Nat. Rev. Rheumatol. 2021, 17(1), 17–33. https://doi.org/10.1038/s41584-020-00541-7
Pitzalis, C.; Choy, E.H.S.; Buch, M.H. Transforming clinical trials in rheumatology: towards patient-centric precision medicine. Nat. Rev. Rheumatol. 2020, 16(10), 590–599. https://doi.org/10.1038/s41584-020-0491-4
Lalor, A.F.; Brooker, J.E.; Rozbroj, T.; et al. Factors influencing clinician prescribing of DMARDs for inflammatory arthritis: a systematic review and thematic synthesis of qualitative studies. Semin. Arthritis Rheum. 2022, 55, 151988. https://doi.org/10.1016/j.semarthrit.2022.151988
Aletaha, D.; Smolen, J.S. The rheumatoid arthritis patient in the clinic: Comparing more than 1300 consecutive DMARD courses. Rheumatology 2002, 41, 1367–1374.
Smolen, J.S.; Aletaha, D.; Machold, K.P. Therapeutic strategies in early rheumatoid arthritis. Best Pract. Res. Clin. Rheumatol. 2005, 19, 163–177.
Smolen, J.S.; Landewé, R.B.M.; Bijlsma, J.W.J.; et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological DMARDs: 2019 update. Ann. Rheum. Dis. 2020, 79(6), 685–699. https://doi.org/10.1136/annrheumdis-2019-216655
Singh, J.A.; Hossain, A.; et al. Biologics or tofacitinib for rheumatoid arthritis in incomplete responders to methotrexate or other traditional DMARDs: A systematic review and network meta-analysis. Cochrane Database Syst. Rev. 2016, Cd012183.
Singh, J.A.; Hossain, A.; Mudano, A.S.; et al. Biologics or tofacitinib for people with rheumatoid arthritis naive to methotrexate: A systematic review and network meta-analysis. Cochrane Database Syst. Rev. 2017, 5, Cd012657.
Simpson, E.L.; Ren, S.; Hock, E.S.; et al. Rheumatoid arthritis treated with 6 months of first-line biologic or biosimilar therapy: An updated systematic review and network meta-analysis. Int. J. Technol. Assess. Health Care 2019, 35, 36–44.
Putrik, P.; Ramiro, S.; Kvien, T.K.; et al. Inequities in access to biologic and synthetic DMARDs across 46 European countries. Ann. Rheum. Dis. 2014, 73, 198–206.
Bergstra, S.A.; Branco, J.C.; Vega-Morales, D.; et al. Inequity in access to bDMARD care and how it influences disease outcomes across countries worldwide: Results from the METEOR registry. Ann. Rheum. Dis. 2018, 77, 1413–1420. https://pubmed.ncbi.nlm.nih.gov/29980576/
Staheli, L.T. Lower extremity management. In: Staheli, L.T.; Hall, J.G.; Jaffe, K.M.; Paholke, D.O., editors. Arthrogryposis: A Text Atlas. Cambridge: Cambridge University Press; 1998. pp. 55–73.
Schlager, L.; Loiskandl, M.; Aletaha, D.; Radner, H. Predictors of successful discontinuation of biologic and targeted synthetic DMARDs in patients with rheumatoid arthritis in remission or low disease activity: a systematic literature review. Rheumatology (Oxford) 2020, 59(2), 324–334.
Lillegraven, S.; Paulshus Sundlisætern, A.; Aga, A.B.; et al. Discontinuation of conventional synthetic DMARDs in patients with rheumatoid arthritis and excellent disease control. JAMA 2023, 329(12), 1024–1026. https://doi.org/10.1001/jama.2023.0492
Entezami, P.; Fox, D.A.; Clapham, P.J.; Chung, K.C. Historical perspective on the etiology of rheumatoid arthritis. Hand Clin. 2011, 27, 1–10. http://dx.doi.org/10.1016/j.hcl.2010.09.006
Schett, G.; Emery, P.; Tanaka, Y.; et al. Tapering biologic and conventional DMARD therapy in rheumatoid arthritis: current evidence and future directions. Ann. Rheum. Dis. 2016, 75, 1428–1437. http://dx.doi.org/10.1136/annrheumdis-2016-209201
van der Heijde, D.M.; van Riel, P.L.; Nuver-Zwart, I.H.; et al. Sulphasalazine versus hydroxychloroquine in rheumatoid arthritis: 3-year follow-up. Lancet 1990, 335, 539. https://pubmed.ncbi.nlm.nih.gov/1968547
van der Heijde, D.; Ramiro, S.; Landewé, R.; et al. 2016 Update of the ASAS-EULAR Management Recommendations for Axial Spondyloarthritis. Ann. Rheum. Dis. 2017, 76, 978–991.
Smolen, J.S.; Landewé, R.B.M. et al. EULAR Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological DMARDs: 2019 Update. Ann. Rheum. Dis. 2020, 79, 685–699.
Favalli, E.G.; Pregnolato, F.; Biggioggero, M.; et al. Twelve-Year Retention Rate of First-Line TNF Inhibitors in Rheumatoid Arthritis: Real-Life Data From a Local Registry. Arthritis Care Res. 2016, 68, 432–439.
Papagoras, C.; Voulgari, P.V.; Drosos, A.A. Strategies after the Failure of the First Anti-TNF Alpha Agent in Rheumatoid Arthritis. Autoimmun. Rev. 2010, 9, 574–582.
Baillet, A.; Payraud, E.; Niderprim, V.A.; et al. A dynamic exercise programme to improve patients’ disability in rheumatoid arthritis: a prospective randomized controlled trial. Rheumatology (Oxford) 2009, 48, 410–415.
Yazici, Y.; Curtis, J.R.; Ince, A.; et al. Efficacy of tocilizumab in patients with moderate to severe active RA and a previous inadequate response to DMARDs: The ROSE study. Ann. Rheum. Dis. 2012, 71, 198–205.
D.; Maranian, P.; Park, G.; et al. Disease progression and treatment responses in a prospective DMARD-naive seropositive early RA cohort: does gender matter? J. Rheumatol. 2010, 37, 2475–2485. https://doi.org/10.3899/jrheum.091432
Jawaheer, D.; Olsen, J.; Hetland, M.L. Sex differences in response to anti-TNF therapy in early and established RA—results from the DANBIO Registry. J. Rheumatol. 2012, 39, 46–53. https://doi.org/10.3899/jrheum.110548
Lend, K.; van Vollenhoven, R.F.; Lampa, J.; et al. Sex differences in remission rates over 24 weeks among three different biologic treatments compared to conventional therapy in early RA (NORD-STAR): post-hoc analysis. Lancet Rheumatol. 2022, 4, e688–e698. https://doi.org/10.1016/S2665-9913(22)00186-2
Teuwen, M.M.H.; Van Weely, S.F.E.; Vliet Vlieland, T.P.M.; et al. Effectiveness of longstanding exercise therapy compared with usual care for people with RA and severe functional limitations: a randomized controlled trial. Ann. Rheum. Dis. 2024, 83, 437–445.
Centers for Disease Control and Prevention. Physical Activity for Arthritis. 2017 April 25. https://www.cdc.gov/arthritis/basics/physical-activity-overview.html
Cooney, J.K.; Law, R.J.; Matschke, V.; et al. Benefits of exercise in rheumatoid arthritis. J. Aging Res. 2011, 2011:681640.
Burska, A.N.; Roget, K.; Blits, M.; et al. Gene expression analysis in RA: towards personalized medicine. Pharmacogenomics J. 2014, 14, 93–106.
Nakamura, S.; Suzuki, K.; Iijima, H.; et al. Identification of baseline gene expression signatures predicting therapeutic responses to three biologic agents in RA: a retrospective observational study. Arthritis Res. Ther. 2016, 18, 159.
Downloads
Published
How to Cite
Issue
Section
