Rheumazentrum Ruhrgebiet, Herne, Germany.
Clin Exp Rheumatol. 2009 Jul-Aug;27(4 Suppl 55):S164-7.
There are clear differences in the clinical picture and in the pathogenesis between rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Biologic agents targeting TNF-alpha are efficacious in both diseases, with some tendency to work even better in spondyloarthritides (SpA) on a clinical basis. However, anti-TNF therapy was shown to inhibit radiographic progression in RA but not in AS. This is probably due to the outstanding difference in pathogenesis: while in RA osteodestructive lesions such as erosions predominate, AS patients will rather develop osteoproliferative changes such as syndesmophytes. There is some evidence that anti-TNF agents may show longterm efficacy and acceptable safety profiles over 5-10 years. There are some differences between the agents.Whether the recent developments of targeted therapies in RA with agents such as rituximab, abatacept and tocilizumab will also work for AS is unknown at present.
类风湿关节炎 (RA) 和强直性脊柱炎 (AS) 的临床表现和发病机制有明显差异。针对肿瘤坏死因子-α (TNF-α) 的生物制剂在这两种疾病中均有效，在基于临床的基础上，对脊柱关节炎 (SpA) 的疗效甚至可能更好。然而，抗 TNF 治疗被证明可以抑制 RA 的放射学进展，但不能抑制 AS 的进展。这可能是由于发病机制的显著差异：在 RA 中，破骨细胞性病变如侵蚀占主导地位，而 AS 患者则会出现骨增生性变化，如骨桥。有一些证据表明，抗 TNF 药物可能在 5-10 年内具有长期疗效和可接受的安全性。不同的药物之间存在一些差异。目前尚不清楚最近在 RA 中使用利妥昔单抗、阿巴西普和托珠单抗等靶向治疗药物的发展是否也适用于 AS。
