Department of Medicine, 562 Heritage Medical Research Building, University of Alberta, Edmonton, Alberta, Canada.
Nat Rev Rheumatol. 2010 Feb;6(2):75-81. doi: 10.1038/nrrheum.2009.258.
The concept of disease modification in ankylosing spondylitis (AS) incorporates aspects of inflammation, bone destruction and new bone formation. The degree to which inflammation and new bone formation are linked remains conjectural, but data from MRI studies of spinal inflammation support the concept of such coupling; however, these studies also suggest a role for the involvement of noninflammatory pathways, such as those involving bone morphogenetic proteins, wingless proteins and Dickkopf-1, in the formation of new bone. The main clinical outcome that reflects disease modification is the modified Stoke Ankylosing Spondylitis Spine Score, which assesses abnormalities in the anterior vertebral corners of the cervical and lumbar spine. However, radiographic progression can only be reliably detected using this method after at least 2 years, and this delay precludes the conduct of placebo-controlled trials on ethical grounds. Preliminary data using this scoring tool suggest that cyclooxygenase-2-selective NSAIDs might reduce disease progression if used continuously over 2 years. By contrast, three different anti-tumor necrosis factor therapies have shown no impact on radiographic progression. Therapeutic trials recruiting patients early in their disease course and at high risk of radiographic progression constitute a high priority for clinical research in AS.
强直性脊柱炎（AS）的疾病修饰概念包含炎症、骨破坏和新骨形成等方面。炎症和新骨形成之间的关联程度仍在推测之中，但来自脊柱炎症 MRI 研究的数据支持这种关联的概念；然而，这些研究还表明，涉及骨形态发生蛋白、无翅蛋白和 Dickkopf-1 等非炎症途径的参与在新骨形成中起作用。反映疾病修饰的主要临床结果是改良的 Stoke 强直性脊柱炎脊柱评分，该评分评估颈椎和腰椎前椎体角的异常。然而，只有在至少 2 年后才能使用这种方法可靠地检测到放射学进展，而这种延迟从伦理角度出发排除了安慰剂对照试验的进行。使用这种评分工具的初步数据表明，环氧化酶-2 选择性 NSAIDs 如果连续使用 2 年以上，可能会减少疾病进展。相比之下，三种不同的抗肿瘤坏死因子治疗方法对放射学进展没有影响。在疾病早期和放射学进展高风险的患者中招募患者的治疗试验是 AS 临床研究的重中之重。
