난치성 류마티스 관절염에서 타크로리무스제제의 효과 평가

Abstract

(Background) Early aggressive treatment with disease modifying antirheumatic drugs (DMARDs) and tumor necrosis factor (TNF) inhibitor can lead to clinical and radiological remission in large proportion of rheumatoid arthritis (RA) patients. Although DMARDs and TNF inhibitor have proved to be effective for refractory RA, many patients are resistant or intolerant to them. Also, they are even contraindicated because of pulmonary complication such as pulmonary tuberculosis. For the reason of endemic area of pulmonary tuberculosis, Korean physicians had limited options for treating a refractory RA patients. Tacrolimus has been used for immunosuppressive therapy in patients with various solid organ and other types of transplants or autoimmune disease. Correlation between tacrolimus and pulmonary tuberculosis or its aggravation has not been well known. It is, therefore, meaningful to look into whether the efficacy of tacrolimus in the refractory RA patient in Korea. The aim of this study is to evaluate efficacy of tacrolimus on refractory RA patients.

(Method) Thirteen patients regarded refractory rheumatoid arthritis were included at Chosun University Hospital from May 2009 to September 2009. We have analysed retrospectively. Whether to be or not the effect of tacrolimus has been examined in two ways : one is comparing erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before and after tacrolimus treatment; the other is also doing ESRand CRP in the same method for the refractory RA patients, non-effect group when the usage of biologics before tacrolimus treatment was applied.

(Result) Both ESR and CRPin the after tacrolimus treatment group have been changed for the better than before tacrolimus treatment group. The differences between them are statistically significant (p<0.016, p<0.013). In the group of usage of biologics before tacrolimus treatment, ESRand CRP have also been improved after tacrolimus treatment, and in this case the differences between after tacrolimus treatment group and before tacrolimus treatment group can be said to have statistical significance (p<0.018, p<0.028).

(Conclusion) Tacrolimus is effective for refractory RA patients who have non-effect in spite of the usage of DMARDs or biologics.

Key word : Tacrolimus, Refractory rheumatoid arthritis, Tuberculosis