Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Clin Exp Rheumatol. 2011 Jul-Aug;29(4):642-9. Epub 2011 Aug 31.
Enthesitis is one of the most common and specific manifestations of ankylosing spondylitis (AS). However, the treatment of enthesitis is still a challenge for rheumatologist so far, especially to those AS patients with serious enthesitis. This study aimed to evaluate the efficacy and safety of ultrasound (US)-guided local injection of etanercept into entheses of AS patients with refractory Achilles enthesitis.
Twelve AS patients with severe unilateral refractory Achilles enthesitis were enrolled. Among them, 5 patients received US-guided local injection of etanercept and the other 7 received betamethasone. BASDAI, BASFI, VAS of the affected heel, the percentage of ASAS20 responders, CRP, ESR and any adverse events were recorded at baseline, 2, 4, 8 and 12 weeks after the treatment. US was also used to evaluate the corresponding entheses at baseline and every follow-up visit.
The BASDAI, BASFI, VAS of the affected heel, CRP, ESR, the percentage of ASAS20 responders and the regional blood flow signals detected by colour Doppler were all improved in both the etanercept group and the betamethasone group, at each follow-up visit compared to the baseline data (p<0.05). There were no significant differences in the improvements of any of the above parameters between the two groups (p>0.05). In addition, there were no adverse events from the etanercept group, except for the mild acid bilges feeling during the injection procedure, while 1 patient from the betamethasone group developed mild local atrophoderma since the week 4 follow-up visit and the atrophoderma kept stable at the 2 subsequent visits.
US-guided local injection of etanercept might be a highly effective, safe and well tolerated treatment for Achilles enthesitis in patients with AS.
附着点炎是强直性脊柱炎（AS）最常见和最具特异性的表现之一。然而，到目前为止，附着点炎的治疗仍然是风湿病学家面临的一个挑战，尤其是对于那些附着点炎严重的 AS 患者。本研究旨在评估超声（US）引导下 AS 患者难治性跟腱附着点炎注射依那西普的疗效和安全性。
纳入 12 例单侧难治性跟腱附着点炎严重的 AS 患者。其中 5 例接受 US 引导下依那西普局部注射，7 例接受倍他米松治疗。在治疗前、治疗后 2、4、8 和 12 周，记录 BASDAI、BASFI、受累足跟 VAS、ASAS20 应答者的百分比、CRP、ESR 和任何不良反应。在基线和每次随访时，还使用 US 评估相应的附着点。
依那西普组和倍他米松组在每个随访时间点的 BASDAI、BASFI、受累足跟 VAS、CRP、ESR、ASAS20 应答者百分比和彩色多普勒检测到的区域血流信号均较基线数据改善（p<0.05）。两组间任何参数的改善均无显著差异（p>0.05）。此外，依那西普组除注射过程中出现轻度反酸感外，无其他不良反应，而倍他米松组 1 例患者从第 4 周随访开始出现轻度局部萎缩，且在随后的 2 次随访中萎缩保持稳定。
US 引导下依那西普局部注射可能是一种治疗 AS 患者跟腱附着点炎的有效、安全且耐受良好的方法。
