Rheumazentrum Ruhrgebiet, Herne, Germany.
Clin Exp Rheumatol. 2011 Sep-Oct;29(5 Suppl 68):S139-42. Epub 2011 Oct 22.
Spondyloarthritides (SpA) are chronic inflammatory rheumatic diseases that usually affect the axial skeleton and may involve entheses and peripheral joints. The main subtypes are ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Other subtypes are reactive arthritis, arthritis associated with chronic inflammatory bowel diseases and undifferentiated axial and peripheral spondyloarthritis. Although SpA were regarded as variants of rheumatoid arthritis (RA) until the 1970s, it is now well established that the pathogenesis of SpA is quite different from that of RA. There is a lack of good clinical studies on glucocorticoid therapy in the SpA. While there is no reasonable doubt that intraarticular local therapies in SpA are as effective as in RA and other forms of arthritis, the evidence for a systemic use is at best marginal. While very high doses may be effective in some patients with AS, the possible value of low-dose corticosteroid therapy in patients with PsA has never been well addressed, with respect to either clinical efficacy or inhibition of radiographic progression. Future studies are needed to clarify this important issue for usual patient care.
脊柱关节炎（SpA）是慢性炎症性风湿性疾病，通常影响轴骨骼，并可能涉及附着点和外周关节。主要亚型有强直性脊柱炎（AS）和银屑病关节炎（PsA）。其他亚型有关节炎、与慢性炎症性肠病相关的关节炎和未分化的轴性和外周性脊柱关节炎。尽管 SpA 直到 20 世纪 70 年代仍被视为类风湿关节炎（RA）的变体，但现在已经明确，SpA 的发病机制与 RA 有很大不同。关于 SpA 中的糖皮质激素治疗，缺乏良好的临床研究。虽然在 SpA 中关节内局部治疗与 RA 和其他形式的关节炎一样有效，这一点毫无疑问，但全身使用的证据最多只是边缘性的。虽然在一些 AS 患者中，高剂量可能有效，但低剂量皮质类固醇治疗在 PsA 患者中的可能价值，无论是在临床疗效还是抑制放射学进展方面，都从未得到很好的解决。需要进一步的研究来阐明这个对常规患者护理很重要的问题。
