Department of Medicine, Medical College, Kolkata, West Bengal 700073, India.
Singapore Med J. 2010 Nov;51(11):883-7.
Bisphosphonates have anti-inflammatory properties in arthritic conditions. This study was conducted to assess the therapeutic potential of intravenous pamidronate in nonsteroidal anti-inflammatory drug (NSAID) refractory/intolerant cases of ankylosing spondylitis (AS).
A total of 35 NSAID refractory/intolerant AS patients with Bath AS Disease Activity Index (BASDAI) score 4 or above were recruited for the study. Monthly pamidronate infusions (60 mg) were administered to the patients for six months. Treatment outcomes were assessed by comparing baseline values with the values after six infusions using BASDAI, Bath AS Functional Index (BASFI), Metrology Index (BASMI) and Global Score (BAS-G), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). An improvement was defined according to the Assessments in Ankylosing Spondylitis (ASAS)-20 and BASDAI-50.
26 patients received all the six infusions. Of these, 22 (85 percent) achieved ASAS-20 and 20 (77 percent) achieved BASDAI-50 responses. Decrements were noted in the mean BASDAI (56.4 percent), BASFI (52.66 percent), BASMI (55.72 percent), BAS-G (66.71 percent), ESR (52.12 percent) and CRP (72.84 percent) after six months. The tender and swollen joint counts of 14 (54 percent) patients with peripheral arthritis were respectively reduced to a mean value of 0.85 and nil, from the baseline of 2.57 and 1.2. Early feel good response was noted in 16 (62 percent) patients within 48 hours of the first infusion. Fever, arthralgia and myalgia were observed in six cases after the first infusion, and in one case, after the second infusion. These symptoms resolved spontaneously within 24 hours.
Intravenous pamidronate has good efficacy for the treatment of AS.
双膦酸盐在关节炎情况下具有抗炎特性。本研究旨在评估静脉帕米膦酸治疗非甾体抗炎药（NSAID）难治/不耐受的强直性脊柱炎（AS）患者的治疗潜力。
共招募 35 例 NSAID 难治/不耐受、Bath AS 疾病活动指数（BASDAI）评分≥4 的 AS 患者。对患者每月给予帕米膦酸 60mg 静脉滴注，共 6 个月。通过 BASDAI、Bath AS 功能指数（BASFI）、Metrology 指数（BASMI）和总体评分（BAS-G）、C 反应蛋白（CRP）和红细胞沉降率（ESR）比较基线值与 6 次输注后的数值，评估治疗效果。根据 ASAS20 和 BASDAI50 评估定义改善。
26 例患者接受了全部 6 次输注。其中，22 例（85%）达到 ASAS20，20 例（77%）达到 BASDAI50 反应。6 个月后，平均 BASDAI（56.4%）、BASFI（52.66%）、BASMI（55.72%）、BAS-G（66.71%）、ESR（52.12%）和 CRP（72.84%）均有下降。14 例（54%）伴外周关节炎的患者的压痛和肿胀关节计数分别从基线的 2.57 和 1.2 减少至平均 0.85 和零。在第一次输注后 48 小时内，16 例（62%）患者出现早期感觉良好反应。6 例患者在第一次输注后出现发热、关节痛和肌痛，1 例患者在第二次输注后出现上述症状，这些症状在 24 小时内自行缓解。
静脉帕米膦酸治疗 AS 疗效良好。
