Brandt J, Sieper J, Braun J
Rheumazentrum Ruhrgebiet, Landgrafenstr. 15, 44652 Herne, Germany.
Z Rheumatol. 2003 Jun;62(3):218-27. doi: 10.1007/s00393-003-0518-7.
The spondyloarthritides (SpA) are common inflammatory rheumatic diseases with an overall prevalence of 0.6-1.9%. Ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA) are the most common subsets of SpA. Women are almost as frequently affected as men, but the total burden of disease may be similar. At least one third of AS patients are severely affected with impaired function and a poor quality of life similar to patients with rheumatoid arthritis. However, AS starts 20-30 years earlier in life. Thus, AS has a relevant socioeconomic impact on society. After decades of no progress concerning treatment options in SpA, there is now accumulating evidence that the new anti-TNF alpha agents do not only reduce signs and symptoms of AS caused by inflammation but they may also diminish structural damage. Very recent magnetic resonance imaging (MRI) data of a follow-up study support this assumption. The following paper reviews the currently available literature on anti-TNF alpha therapy in AS and uSpA. Efficacy, side effects and experiences with different doses are discussed. In expectation of the approval of infliximab and etanercept for the treatment of active AS international guidelines for initiation, monitoring and discontinuation of these agents have been recently proposed.
脊柱关节炎（SpA）是常见的炎性风湿性疾病，总体患病率为0.6%-1.9%。强直性脊柱炎（AS）和未分化脊柱关节炎（uSpA）是SpA最常见的亚型。女性受影响的频率几乎与男性相同，但疾病的总体负担可能相似。至少三分之一的AS患者受到严重影响，功能受损，生活质量较差，与类风湿关节炎患者相似。然而，AS发病比类风湿关节炎早20-30年。因此，AS对社会有重大的社会经济影响。在SpA治疗方案几十年没有进展之后，现在越来越多的证据表明，新型抗TNF-α药物不仅能减轻AS炎症引起的体征和症状，还可能减少结构损伤。一项随访研究最近的磁共振成像（MRI）数据支持这一假设。以下论文综述了目前关于AS和uSpA抗TNF-α治疗的文献。讨论了不同剂量的疗效、副作用及经验。鉴于英夫利昔单抗和依那西普有望获批用于治疗活动性AS，最近有人提出了这些药物起始、监测和停药的国际指南。
