Prospective Study
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World J Rheumatol. Mar 12, 2014; 4(1): 1-5
Published online Mar 12, 2014. doi: 10.5499/wjr.v4.i1.1
TNF-α inhibitors and tocilizumab do not influence hepatic steatosis in patients with rheumatoid arthritis
Paola Sessa, Matteo Nicola Dario Di Minno, Rosella Tirri, Carmine Finelli, Gabriele Valentini, Giovanni Tarantino
Paola Sessa, Rosella Tirri, Gabriele Valentini, Rheumatology Unit, Second University of Naples, 80131 Naples, Italy
Matteo Nicola Dario Di Minno, Giovanni Tarantino, Department of Clinical Medicine and Surgery, Federico II University Medical School of Naples, 80131 Naples, Italy
Carmine Finelli, Center of Obesity and Eating Disorders, Stella Maris Mediterraneum Foundation, C/da S. Lucia, Chiaromonte, 80035 Potenza, Italy
Giovanni Tarantino, National Cancer Institute “Pascale Foundation” IRCSS, Mercogliano (AV), 80131 Naples, Italy
Author contributions: Sessa P selected patients, gathered clinical data, performed statistical analysis and drafted the manuscript; Tarantino G evaluated imaging tools; Di Minno MND, Finelli C and Tarantino G critically revised the manuscript; Tirri R helped select patients, run statistics and draft the manuscript; Valentini G designed the study.
Correspondence to: Giovanni Tarantino, MD, Professor, Department of Clinical Medicine and Surgery, Federico II University Medical School of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy. tarantin@unina.it
Telephone: +39-81-7462024 Fax: +39-81-5466152
Received: January 5, 2014
Revised: March 1, 2014
Accepted: March 6, 2014
Published online: March 12, 2014
Abstract

AIM: To investigate the influence, if any, of tumor necrosis factor (TNF)-α inihibitors and Tocilizumab, on hepatic steatosis (HS) in rheumatoid arthritis (RA) patients in the light of the known role of TNF-α and interleukin-6, which are key-cytokines in the pathogenesis of RA, in inducing HS in general population.

METHODS: We retrospectively reviewed the clinical charts of 36 RA patients, out of whom 12 had been treated with Methotrexate (MTX), 12 with TNF inhibitors ± MTX and 12 with Tocilizumab ± MTX. The 3 subgroups of patients matched each other for sex, age, body mass index, metabolic syndrome (MS) and other risk factors for atherosclerosis. At baseline and after 12 mo each patient underwent an abdominal ultrasonography for the assessment of presence of HS and the evaluation of its grade.

RESULTS: No difference was detected either in the prevalence of HS or in that of its distinct grades between the 3 groups of patients at baseline. After 12 mo, the HS grade unchanged in 20 patients (7 subjects treated with MTX, 7 with TNF-α inhibitors ± MTX and 6 Tocilizumab ± MTX); increased in 12 patients (4 subjects treated with MTX, 4 TNF-α blockers ± MTX and 4 Tocilizumab ± MTX); decreased in 4 (1 treated with MTX, 1 with anti-TNF-α + MTX and 2 with TCZ ± MTX (P = 0.75). No correlation was found between getting remission or low disease activity and the course of either MS or HS.

CONCLUSION: We failed to detect any influence of MTX ± TNF-α inhibitors or Tocilizumab in reducing MS and HS. A prospective study is needed to clarify the topic.

Keywords: Steatosis, Rheumatoid arthritis, Biological agents

Core tip: Tumor necrosis factor (TNF)-α and interleukin-6 are not only key-cytokines in the pathogenesis of rheumatoid arthritis (RA) but can also inducing hepatic steatosis (HS) in general population. RA patients treated with Methotrexate (MTX) or TNF-α inhibitors or Tocilizumab underwent an abdominal ultrasonography for the assessment of presence of HS and the evaluation of its grade. At baseline and after 12 mo no difference was detected either in the prevalence of HS or in that of its distinct grades between the patients treated with MTX or TNF-α inhibitors or Tocilizumab.