Rheumatoid arthritis (RA) is a clinically heterogeneous and complex autoimmune disease, making the prediction of therapeutic responses a significant challenge. This study aims to assess the role of clinical and synovial biomarkers in predicting poor response to adalimumab treatment in RA patients. This single-center prospective study included 56 RA patients who had an inadequate response to methotrexate (MTX). At baseline, comprehensive assessments including complete blood count, liver and kidney function tests, blood glucose levels, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-citrullinated protein antibody (ACPA), as well as counts of swollen and tender joints, Health Assessment Questionnaire (HAQ) score, pain visual analogue scale (VAS) scores, and DAS28-CRP scores were conducted. Synovial biopsies were performed, followed by an efficacy evaluation at 12 weeks of adalimumab treatment. Patients not meeting the ACR20 criteria were classified into the non-responder group, with the remainder categorized as the responder group. Out of the participants, 24 (42.9%) failed to achieve ACR20 with adalimumab treatment. Non-responders exhibited higher infiltration of plasma cells in the synovium. Multivariate logistic regression analysis identified the presence of plasma cells as an independent risk factor for inadequate response to adalimumab. Inadequate responses to adalimumab in RA patients were associated with increased plasma cell infiltrations in the synovium. These findings suggest a promising target for tailored therapies in rheumatoid arthritis.

中文翻译：

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滑膜中浆细胞的浸润预示着类风湿性关节炎患者对阿达木单抗的反应不足


类风湿性关节炎 （RA） 是一种临床异质性和复杂的自身免疫性疾病，这使得治疗反应的预测成为一项重大挑战。本研究旨在评估临床和滑膜生物标志物在预测 RA 患者对阿达木单抗治疗反应不佳中的作用。这项单中心前瞻性研究包括 56 例对甲氨蝶呤 （MTX） 反应不足的 RA 患者。基线时，进行全面评估，包括全血细胞计数、肝肾功能检查、血糖水平、红细胞沉降率 （ESR）、C 反应蛋白 （CRP）、类风湿因子 （RF）、抗瓜氨酸蛋白抗体 （ACPA），以及关节肿胀和压痛计数、健康评估问卷 （HAQ） 评分、疼痛视觉模拟量表 （VAS） 评分和 DAS28-CRP 评分。进行滑膜活检，然后在阿达木单抗治疗 12 周时进行疗效评估。不符合 ACR20 标准的患者被归类为无反应组，其余患者被归类为反应组。在参与者中，24 名 （42.9%） 在阿达木单抗治疗中未能达到 ACR20。无反应者在滑膜中表现出更高的浆细胞浸润。多变量 logistic 回归分析确定浆细胞的存在是对阿达木单抗反应不足的独立危险因素。RA 患者对阿达木单抗的反应不足与滑膜浆细胞浸润增加有关。这些发现表明了类风湿性关节炎定制疗法的一个有前途的靶点。