Department of Rheumatology, Gent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium.
Clin Rheumatol. 2010 Mar;29(3):281-8. doi: 10.1007/s10067-009-1317-6. Epub 2009 Dec 3.
Ankylosing spondylitis (AS) is a disabling inflammatory disease accompanied by a variety of extra-articular manifestations in a significant number of patients. These manifestations, including Crohn's disease, ulcerative colitis, psoriasis, and uveitis, share a similar inflammatory mechanism with one another and with AS. Extra-articular manifestations are observed in a larger percentage of patients with AS and spondyloarthritides (SpAs) than the normal population; therefore, it is important to identify these and other inflammatory-mediated conditions and consider them when treating SpAs. How rheumatologists approach patients with both AS and extra-articular manifestations may lead to a better understanding of what treatment approaches could be taken to optimize patient outcomes. Rheumatologists (N = 453) from five European countries and Canada who treat AS were surveyed to determine treatment practices and management of both AS and its associated extra-articular manifestations. Most rheumatologists (93%) believe AS could be diagnosed earlier as the average time between symptom onset and diagnosis was approximately 4 years. In total, 60% routinely screen patients with AS for extra-articular manifestations, although this varied considerably across countries. The majority (97%) agrees that controlling inflammation is critical during treatment, and patients with extra-articular manifestations tend to have poorer prognoses than those patients with only axial AS. Treatment considerations varied depending on whether patients presented with only axial AS or had extra-articular manifestations, where use of biologics became more common. Rheumatologists agree that patients with both AS and extra-articular manifestations require a different treatment strategy than patients with AS alone. Results of this survey highlight areas where rheumatologists differ in their clinical management of patients with AS including tools used for disease assessment and the routine screening, or lack thereof, for other inflammatory diseases. This evidence may suggest aspects within clinical practice where modifications may be made in order to optimize patient outcomes.
强直性脊柱炎（AS）是一种致残性炎症性疾病，在相当数量的患者中伴有多种关节外表现。这些表现与 AS 以及与 AS 具有相似炎症机制的疾病（如克罗恩病、溃疡性结肠炎、银屑病和葡萄膜炎）相互关联。AS 和脊柱关节炎（SpA）患者中出现关节外表现的比例高于普通人群；因此，识别这些表现和其他炎症介导的疾病并在治疗 SpA 时考虑这些疾病非常重要。风湿科医生对同时患有 AS 和关节外表现的患者的治疗方法可能有助于更好地理解可以采取哪些治疗方法来优化患者的治疗效果。来自五个欧洲国家和加拿大的 453 名治疗 AS 的风湿科医生接受了调查，以确定他们的治疗方法和 AS 及其相关关节外表现的管理方法。大多数风湿科医生（93%）认为可以更早诊断出 AS，因为症状出现和诊断之间的平均时间约为 4 年。总的来说，尽管各国之间存在较大差异，但有 60%的医生会定期对 AS 患者进行关节外表现筛查。大多数（97%）医生认为在治疗过程中控制炎症至关重要，而且有关节外表现的患者预后往往比只有轴性 AS 的患者差。治疗考虑因素因患者是否仅出现轴性 AS 或存在关节外表现而异，在存在关节外表现的情况下，生物制剂的使用更为常见。风湿科医生一致认为，同时患有 AS 和关节外表现的患者需要与仅患有 AS 的患者采用不同的治疗策略。这项调查的结果强调了风湿科医生在 AS 患者的临床管理方面存在差异的领域，包括用于疾病评估的工具以及是否对其他炎症性疾病进行常规筛查。这些证据可能表明，在临床实践中，为了优化患者的治疗效果，可以对某些方面进行调整。
