Infliximab治療はmethotrexate単独治療と比較してより強力に関節リウマチ患者の抑うつ状態を改善する  [in Japanese] Infliximab Therapy may Improve Depression in Patients with Rheumatoid Arthritis in Comparison with Methotrexate Monotherapy  [in Japanese]

関節リウマチ(RA)患者は健常人よりも抑うつ傾向が強く,一方infliximab (Ifx)はRAに対する治療効果発現が早く,有効性が高いことが知られている.そこでIfxにてRA患者の抑うつ状態が改善するか検討した. Ifx治療RA患者10例(A群)に対し,治療開始前,投与2,6,14,22,30週後にSelf-rating Depression Scale (SDS)を施行し,治療開始前と比較し,SDSとDAS (disease activity score) 28の変化を検討.対照としてmethotrexate治療19例(B群)も同様に施行. SDSは両群ともに低下し,個体間変動p=0.006と薬剤による差を認めた. DASは両群ともに低下傾向であったが,個体間変動p=0.456と薬剤による差を認めなかった.今回の研究は予備的研究であるが, IfxはRAの疾患活動性を低下させることで抑うつ状態を改善させるのみならず,脳神経系への直接作用などを介している可能性が示唆された.

Objective : Depression is known to be an important complication in patients with rheumatoid arthritis (RA). Availability of Infliximab (Ifx) treatment for RA is high. Therefore we determined whether depressive states of RA patients are improved by Ifx treatment. Method : We performed Self-rating Depression Scales (SDS) and disease activity score 28 (DAS28 ESR4) to 10 RA patients using Ifx treatment before and after treatment for 2,6,14,22 and 30 weeks. We compared SDS with DAS28 before and after Ifx treatment and reviewed. Nineteen patients started methotrexate (MTX) monotherapy as a control group. Analysis methods included repeated measure analysis of variance (ANOVA) , Mann-Whitney's U test and Fisher's exact probability test by Stat View, ver5.0 (SAS company Co. Ltd.). Results : No significant difference was found in the two groups as to age, sex and dosage of steroid by Mann-Whitney's U test and Fisher's exact probability test. SDS and DAS28 before treatment also showed no significant difference in the two groups. Comparison of SDS in the two groups showed no interaction (p=0.779) in both groups and variation between individuals and intra-subject variation showed significant difference (p=0.006 and p=0.001) according to the repeated measure analysis of variance (ANOVA). However when DAS28 was compared in the two groups, interaction was found (p=0.001). Not yet being scientifically accurate, Ifx showed no significant difference in variation between individuals (p=0.456), but significant difference in intra-subject variation (p=0.001). Conclusion : Although this is a pilot study, it is suggested that Ifx may improve depressive state by decreasing disease activities of RA by way of direct action to the central nerve system.