Baraliakos X, Listing J, Brandt J, Haibel H, Rudwaleit M, Sieper J, Braun J
Rheumazentrum Ruhrgebiet, Herne, Ruhr-University Bochum, Germany.
Rheumatology (Oxford). 2007 Sep;46(9):1450-3. doi: 10.1093/rheumatology/kem166. Epub 2007 Jul 10.
Anti-tumour necrosis factor therapy with infliximab has been shown to improve signs and symptoms of patients with active ankylosing spondylitis (AS). The objective of this article was to study the effect of infliximab on structural changes in AS over 4 yrs.
Conventional radiographs of the cervical and the lumbar spine of 33 AS patients at baseline (BL), after 2 (FU1) and after 4 yrs (FU2) of infliximab therapy were scored by the modified Stokes ankylosing spondylitis spinal score (mSASSS). Definite baseline damage was defined when at least one syndesmophyte (mSASSS >/=2) was seen. Definite radiographic progression was defined as a change from 0 or 1 to syndesmophytes or ankylosis (mSASSS >/=2).
The mean change over 4 yrs was 1.6 +/- 2.6 mSASSS units (P = 0.001), (0.9 +/- 2.3 for BL-FU1 vs 0.7 +/- 1.6 for FU1-FU2). This is less radiographic progression in comparison with published data from the OASIS cohort (4.4 within 4 yrs). Definite radiographic progression was found in 10/33 (30.3%) patients for BL-FU2. Patients with definite damage at BL developed more chronic changes at FU2 (2.3 +/- 3.1, P = 0.003) than those with no damage at BL (0.7 +/- 1.5, P = 0.08). Four out of seven patients with no damage at BL showed radiographic deterioration after 4 yrs. The change of the mean mSASSS in comparison with BL was significantly different after 2 (P = 0.007) but not after 4 yrs of infliximab therapy.
There is some radiographic progression after 2 and 4 yrs of infliximab therapy in AS patients. A comparison with the historical OASIS cohort suggests that infliximab may decelerate progression of structural changes. Larger studies are needed to confirm this finding.
已证实英夫利昔单抗抗肿瘤坏死因子疗法可改善活动性强直性脊柱炎（AS）患者的体征和症状。本文旨在研究英夫利昔单抗在4年期间对AS结构改变的影响。
采用改良斯托克斯强直性脊柱炎脊柱评分（mSASSS）对33例AS患者在英夫利昔单抗治疗基线期（BL）、治疗2年（FU1）和4年（FU2）后的颈椎和腰椎X线平片进行评分。当至少观察到一个韧带骨赘（mSASSS≥2）时定义为明确的基线损伤。明确的影像学进展定义为从0或1级变为韧带骨赘或强直（mSASSS≥2）。
4年期间的平均变化为1.6±2.6 mSASSS单位（P = 0.001），（基线期至FU1为0.9±2.3，FU1至FU2为0.7±1.6）。与OASIS队列公布的数据相比，影像学进展较少（4年内为4.4）。在基线期至FU2期间，10/33（30.3%）的患者出现明确的影像学进展。基线期有明确损伤的患者在FU2期出现更多慢性改变（2.3±3.1，P = 0.003），而基线期无损伤的患者为（0.7±1.5，P = 0.08）。7例基线期无损伤的患者中有4例在4年后出现影像学恶化。英夫利昔单抗治疗2年后，平均mSASSS与基线期相比有显著差异（P = 0.007），但4年后无差异。
AS患者接受英夫利昔单抗治疗2年和4年后存在一定程度的影像学进展。与历史OASIS队列相比，提示英夫利昔单抗可能减缓结构改变的进展。需要更大规模的研究来证实这一发现。
