[EULAR文摘] 脊柱放射学持续进展是否显著影响关节功能

脊柱放射学持续进展是否显著影响关节功能

Poddubnyy D, et al. EULAR 2015. Present ID: THU0199.

背景: 强直性脊柱炎(AS)患者的机体功能和脊柱活动性由于脊柱炎症和新骨形成而受到损害。研究已证实抗TNF治疗可以减轻炎症, 但尚不清楚能否影响放射学进展。

目的: 探讨长期(长达10年)应用抗TNF治疗对AS患者放射学进展的作用以及该进展对机体功能及脊柱活动的影响。

方法: 共60例AS患者来自2项TNF拮抗剂长期观察研究 (英利昔单抗43例 [1], 依那西普17例[2])。本研究采用完成试验者分析对脊柱X线病变进行统计分析。患者在基线和第2、4、6、8和10年进行脊柱 X线侧位摄片检查颈椎和腰椎。由两位阅片师(DP和AF)评估改良斯托克强直性脊柱炎脊柱评分(mSASSS), 他们知晓随访时间点。通过BASFI评估机体功能状态, 由通过BAMI(0-10)评估脊柱活动性, 通过BASDAI评估临床病情活动度。

结果: 接受英夫利昔单抗​​和依那西普治疗的患者的基线临床特征无显著差异(年龄, 性别, HLA-B27, 病程, 病情活动度和基线结构损坏), 故将这两种药物的数据加以合并。两位阅片师之间对mSASSS判读一致性很好, 组内在任何随访点的相关系数>0.9。在图中我们展示了组水平的mSASSS、BASDAI、BASFI和BASMI在10年间的观察值。接受抗TNF治疗后, BASFI快速改善并在10年间相当稳定地维持在低分值, 而这些患者的mSASSS在10年间增加了6分。与BASFI相似, BASMI在应用抗TNF之后显著改善, 在10年间也维持在较低分值, 基线3.5, 第2年 2.5, 第4年 2.1, 第6年2.1, 第8年2.5, 第10年2.7。BASDAI也在10年间维持小于3分, 表明对疾病活动度的良好控制。

结论: 尽管长期抗TNF治疗的患者中出现一些放射学进展, 但患者的机体功能装提保持稳定。在这些情况下, BASFI变化与BASDAI相关而与mSASSS不相关。这可能提示, 良好地控制炎症能抵消脊柱结构破坏对关节功能的负面影响。

                    

图1. 强直性脊柱炎患者接受TNFi治疗10年间的脊柱放射学进展(mSASSS)、功能状态(BASFI)和病情活动度(BASDAI)的变化.

 

原文链接或参见以下信息。

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Ann Rheum Dis2015;74:267doi:10.1136/annrheumdis-2015-eular.3774

• Poster Presentations

THU0199 Functional Status Remains Stable Despite Continuous Radiographic Spinal Progression Over Ten Years in Patients with Ankylosing Spondylitis Receiving Anti-TNF Therapy

1. D. Poddubnyy¹, 
2. A. Fedorova¹, 
3. J. Listing², 
4. H. Dyck², 
5. H. Haibel¹, 
6. X. Baraliakos³, 
7. J. Braun³,
8. J. Sieper¹

-Author Affiliations

1. ¹Charité Universitätsmedizin Berlin
2. ²German Rheumatism Research Centre, Berlin
3. ³Rheumazentrum Ruhrgebiet, Herne, Germany

1. ¹Charité Universitätsmedizin Berlin
2. ²German Rheumatism Research Centre, Berlin
3. ³Rheumazentrum Ruhrgebiet, Herne, Germany

Abstract

Background Impaired function and spinal mobility in patients with ankylosing spondylitis (AS) can be caused by both spinal inflammation and new bone formation. Anti-TNF therapy has been shown to reduce inflammation but the influence on radiographic progression is less clear.

Objectives To investigate the impact of long-term (up to 10 years) anti-TNF therapy on function and spinal mobility in relation to radiographic progression in the spine in patients with AS.

Methods Altogether 60 patients with AS from two long-term trials with TNF blockers (43 on infliximab [1] and 17 on etanercept [2]) were included in this completer analysis based on availability of spinal x-rays performed at baseline and at least at one following time-point (year 2, 4, 6, 8, 10) during the follow-up. Spinal radiographs (cervical and lumbar spine lateral views) were scored according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) system by two readers (DP and AF) not blinded for the time point. The functional status was assessed by means of the Bath Ankylosing Spondylitis Functional Index (BASFI), spinal mobility – by the Bath Ankylosing Spondylitis Metrology Index (BASMI, 0-10), and clinical disease activity - by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).

Results Patients treated with infliximab and etanercept had similar baseline characteristics with regards of age, gender, HLA-B27 status, symptom duration, disease activity and baseline structural damage that allowed pooling of the data. There was a good agreement between readers regarding the mSASSS with an intra-class correlation coefficients of >0.9 at all time-points. The dynamics of the mSASSS score, BASDAI, BASFI and BASMI over 10 years at the group level (data as observed) are presented in the figure. After the BASFI had initially improved significantly in response to anti-TNF therapy in those patients who remained on the drug over time it remained remarkably stable at low levels over 10 years despite the observed increase of the mSASSS by 6 points in the same patients. Similarly, BASMI had improved significantly after initiation of anti-TNF therapy and remained at the low level until year 10: baseline – 3.5, year 2 – 2.5, year 4 – 2.1, year 6 – 2.1, year 8 – 2.5, year 10 – 2.7. The BASDAI also remained stable at levels <3 indicating good control of disease activity.

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Conclusions Functional status in patients with advanced AS remained stable during long-term anti-TNF therapy despite some radiographic progression. Under these conditions the BASFI course correlated strongly with BASDAI but not with the mSASSS. This might indicate that a good control of inflammation is able to overweight the negative effect of structural damage in the spine on the functional status in AS.

References

1. Braun J, et al. Lancet 2002;359:1187-93.

2. Brandt J, et al. Arthritis Rheum 2003;48:1667-75.