Frech Tracy
University of Utah, Division of Rheumatology, UT, USA.
Biologics. 2007 Mar;1(1):45-51.
Ankylosing spondylitis is a chronic inflammatory condition which preferentially affects the axial skeleton, often beginning in the sacroiliac joints. The etiology of the pathologic lesions of this condition including enthesitis, erosive articular changes, osteitis, and fibrous ankylosis, as well as changes which occur in the eye, gastrointestinal tract, cardiovascular system, and lungs is unknown; however, there is a strong association with HLA-B27, which indicates altered immunity. One of the major mediators of the immune response is TNF-alpha, which functions as a pleiotrophic soluble messenger primarily from macrophages. TNF-alpha is principally involved with activation of both normal and transformed cells, including endothelium, synoviocytes, osteoclasts, chondrocytes, and fibroblasts. The cornerstone of medical management of ankylosing spondylitis includes intensive physical therapy and nonsteroidal anti-inflammatories for symptomatic relief. However, it is becoming increasingly recognized that TNF-alpha blockade has an important role in the reduction of spine and joint inflammation. This review discusses the data that supports use of etanercept in the treatment of ankylosing spondylitis.
强直性脊柱炎是一种慢性炎症性疾病，主要累及中轴骨骼，通常始于骶髂关节。该疾病病理病变的病因，包括附着点炎、侵蚀性关节改变、骨炎和纤维性强直，以及眼部、胃肠道、心血管系统和肺部出现的变化尚不清楚；然而，它与HLA - B27密切相关，这表明免疫功能发生了改变。免疫反应的主要介质之一是肿瘤坏死因子 - α（TNF - α），它主要作为一种多效性可溶性信使分子，由巨噬细胞产生。TNF - α主要参与正常细胞和转化细胞的激活，包括内皮细胞、滑膜细胞、破骨细胞、软骨细胞和成纤维细胞。强直性脊柱炎医学治疗的基石包括强化物理治疗和使用非甾体抗炎药以缓解症状。然而，越来越多的人认识到，阻断TNF - α在减轻脊柱和关节炎症方面具有重要作用。本综述讨论了支持使用依那西普治疗强直性脊柱炎的数据。
