尽早长期使用TNF-α抑制剂可缓解强直性脊柱炎患者影像学进展

尽早长期使用TNF-α抑制剂

可缓解强直性脊柱炎患者

影像学进展

目 标

评估使用TNF-α抑制剂治疗强直性脊柱炎（AS）的影像学进展。

方 法

本研究对象为一家三级医院1995年至2014年期间接受TNFi治疗且至少每2年接受一次影像学病情评估的AS患者。启用TNFi的时间定义为从症状发作到开始使用TNFi的时间。TNFi指数定义为TNFi使用期与整个疾病期的比率。通过改良Stroke强直性脊柱炎脊柱评分法（mSASSS）评估影像学损伤。使用单变量和多变量线性回归分析来确定影响患者影像学进展的因素。

结 果

共有151名患者被纳入分析。17名（11.3％）患者为女性，年平均mSASSS为1.01单位/年。 平均X射线随访时间为102.9±54.9个月。 从症状发作到开始使用TNFi的平均时间为104.8±83.6个月（中位数84个月），平均TNFi指数为42.9±23.8％（中位数为40.9％）。 在多变量分析中，初始mSASSS、初始C反应蛋白、体重指数、现时吸烟者和TNFi的使用延迟与放射学进展相关。外周关节炎和TNFi指数与放射学进展呈负相关。

结 论

TNF-α抑制剂可以延缓AS患者影像学进展，尤其是对于尽早使用和长期维持的患者来说保护效应更佳。

原 文

Effect of tumor necrosis factor α inhibitors on spinal radiographic progression in patients with ankylosing spondylitis

Aim

To evaluate the effect of tumor necrosis factor α inhibitors (TNFi) on spinal radiographic progression in patients with ankylosing spondylitis (AS).

Methods

Subjects were selected from patients at a single tertiary hospital between 1995 and 2014. Patients who used TNFi with baseline and paired follow‐up radiographic data with a minimum interval of 2 years were included. Time to start TNFi was defined as the time from symptom onset to the start of TNFi use. TNFi index was defined as the ratio of the period of TNFi use to the entire period of disease. Radiographic damage was assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Univariable and multivariable linear regression analyses were used to identify factors associated with radiographic progression.

Results

A total of 151 patients were included in the analysis. Seventeen (11.3%) patients were female and mean ΔmSASSS/year was 1.01 units/year. Mean X‐ray follow‐up duration was 102.9 ± 54.9 months. Mean time from symptom onset to start of TNFi use was 104.8 ± 83.6 months (median 84 months) and mean TNFi index was 42.9 ± 23.8% (median 40.9%). In multivariable analysis, initial mSASSS, initial C‐reactive protein, body mass index, current smoker, and delayed start of TNFi use were associated with radiographic progression. Presence of peripheral arthritis and the TNFi index were negatively associated with radiographic progression.

Conclusions

A delay in starting TNFi use and low TNFi index were associated with radiographic progression. Early and long‐term use of TNFi appear to reduce spinal radiographic progression in patients with AS.

文章出处：

Hyemin Jeong, Yeong Hee Eun, In Young Kim, Eun‐Jung Park, Hyungjin Kim, Jaejoon Lee, Chan Hong Jeon, Eun‐Mi Koh, Hoon‐Suk Cha. International Journal of Rheumatic Diseases. 2-Apr-18.

https://onlinelibrary.wiley.com/doi/abs/10.1111/1756-185X.13270