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双膦酸盐在强直性脊柱炎中的抗炎治疗

Antiinflammatory treatment with bisphosphonates in ankylosing spondylitis.

作者信息

Toussirot Eric, Wendling Daniel

机构信息

Department of Rheumatology, University Hospital Jean Minjoz, Besançon cedex, France.

出版信息

Curr Opin Rheumatol. 2007 Jul;19(4):340-5. doi: 10.1097/BOR.0b013e328133f57b.

Abstract

PURPOSE OF REVIEW

Bisphosphonates are antiosteoclastic agents widely used in the treatment of bone diseases. They also have antiinflammatory properties suggested by a clinical amelioration in animal models of arthritis. Bisphosphonates act on cells from the monocyte/macrophage lineage and may modulate the generation of proinflammatory cytokines. Ankylosing spondylitis is characterized by bone marrow subchondral inflammation with the presence of T cells and macrophages, and osteoporosis is a well known complication of the disease. Thus, bisphosphonates may be reasonably used as a therapeutic agent in ankylosing spondylitis.

RECENT FINDINGS

Different open trials have shown that the amino bisphosphonate pamidronate ameliorated the clinical symptoms of ankylosing spondylitis, mainly axial disease, and in one study, peripheral arthritis. Laboratory parameters of inflammation were, in general, not influenced while biochemical markers of bone turnover fell significantly under pamidronate. Imaging modifications of the inflammatory lesions using MRI were also improved with pamidronate. A dose-controlled study demonstrated a higher efficacy for 60 mg pamidronate compared with a 10 mg dose.

SUMMARY

The amino bisphosphonate pamidronate has shown clinical and radiological amelioration in ankylosing spondylitis patients, although this improvement is mild and transient. Additional studies are required to better define the real impact of pamidronate on ankylosing spondylitis and its place among the different treatment options for the disease.

摘要

综述目的

双膦酸盐是广泛用于治疗骨疾病的抗破骨细胞药物。在关节炎动物模型中,临床症状改善提示其也具有抗炎特性。双膦酸盐作用于单核细胞/巨噬细胞谱系的细胞,可能调节促炎细胞因子的产生。强直性脊柱炎的特征是骨髓软骨下炎症伴T细胞和巨噬细胞存在,骨质疏松是该疾病的一种众所周知的并发症。因此,双膦酸盐可合理用作强直性脊柱炎的治疗药物。

最新发现

不同的开放性试验表明,氨基双膦酸盐帕米膦酸钠改善了强直性脊柱炎的临床症状,主要是轴性疾病,并且在一项研究中还改善了外周关节炎。炎症的实验室参数总体上未受影响,而在帕米膦酸钠治疗下骨转换的生化标志物显著下降。使用MRI对炎性病变进行的影像学改变也因帕米膦酸钠而得到改善。一项剂量对照研究表明,60mg帕米膦酸钠的疗效高于10mg剂量。

总结

氨基双膦酸盐帕米膦酸钠已在强直性脊柱炎患者中显示出临床和影像学改善,尽管这种改善是轻微且短暂的。需要进一步研究以更好地确定帕米膦酸钠对强直性脊柱炎的实际影响及其在该疾病不同治疗选择中的地位。

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