Rheumazentrum Ruhrgebiet, Herne, Germany.
Clin Exp Rheumatol. 2009 Jul-Aug;27(4 Suppl 55):S146-7.
The treatment of the two most frequent inflammatory rheumatic diseases rheumatoid arthritis (RA) and ankylosing spondylitis (AS) has some similarities but in total more differences. Thus, therapy with non-steroidal anti-inflammatory agents (NSAIDs), conventional disease modifying anti-rheumatic drugs (DMARDs) and biologic agents has a different role in the management and different efficacy in AS and RA. This implies signs and symptoms, function, and structural damage. This is in part due to the different pathogenesis: (i) while the synovium is an important target in RA it is rather the bone in AS and (ii) while the pathology in RA is rather osteodestructive to cartilage and bone presenting with erosions, it is predominantly osteoproliferative in AS as indicated by syndesmophytes and ankylosis. Biologic agents targeting tumor necrosis factor (TNF-alpha) work clinically well in both diseases but, while they clearly inhibit structural damage in RA, they do not seem to have much influence on new bone formation in AS. DMARDs are efficacious in RA but less so in AS. NSAIDs are efficacious in both RA and AS, but they are considered first line of therapy in AS while they are rather adjunctive agents in RA. In AS, NSAIDs, potentially especially coxibs, may even prevent new bone formation due to their inhibitory effect on cyclooxygenase-2.
治疗两种最常见的炎症性风湿病类风湿关节炎（RA）和强直性脊柱炎（AS）有一些相似之处，但总的来说更多的是不同之处。因此，非甾体抗炎药（NSAIDs）、传统的疾病修饰抗风湿药物（DMARDs）和生物制剂的治疗在 AS 和 RA 的管理中有不同的作用，疗效也不同。这意味着症状、功能和结构损伤。这部分是由于发病机制不同：（i）虽然滑膜是 RA 的重要靶点，但在 AS 中更重要的是骨骼；（ii）虽然 RA 的病理学主要是破坏软骨和骨骼，表现为侵蚀，但在 AS 中主要是骨增生，表现为骨桥和融合。针对肿瘤坏死因子（TNF-α）的生物制剂在这两种疾病中都有很好的临床疗效，但它们在 RA 中明显抑制结构损伤，在 AS 中似乎对新骨形成没有太大影响。DMARDs 在 RA 中有效，但在 AS 中效果较差。NSAIDs 在 RA 和 AS 中均有效，但在 AS 中被认为是一线治疗药物，而在 RA 中则是辅助治疗药物。在 AS 中，由于环加氧酶-2 的抑制作用，NSAIDs，尤其是 COX-2 抑制剂，甚至可能预防新骨形成。
