Perrotta F M, Addimanda O, Ramonda R, D'Angelo S, Lubrano E, Marchesoni A, Olivieri I, Punzi L, Salvarani C, Spadaro A
UOC di Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Università La Sapienza, Roma.
Reumatismo. 2014 Nov 6;66(3):208-14. doi: 10.4081/reumatismo.2014.756.
The objective of this study was to evaluate the predictive factors for achieving partial remission (PR) in patients with ankylosing spondylitis (AS) treated with anti-TNFα. We longitudinally enrolled in a multi-center study 214 AS patients, classified according to New York criteria, treated with anti-TNFα drugs adalimumab (ADA), etanercept (ETA) and infliximab (INF) with at least 12 months of follow up. PR was reached when the score was <20 mm (on a visual analogue scale of 0-100 mm) in each of the following 4 domains: 1) patient global assessment (in the last week); 2) pain (spinal pain); 3) function [measured by the bath ankylosing spondylitis functional index (BASFI)]; 4) inflammation [mean of intensity and duration of morning stiffness, from the bath ankylosing spondylitis disease activity index (BASDAI)]. Two hundred fourteen AS patients (M/F=160/54; median age/range=43.2/19-78 years; median disease duration/ range=96/36-189 months) were treated with ADA (15.8%), ETA (28.9%) and INF (55.1%). At 12 and 24 months, high serum level of C reactive protein (CRP) (≥2 vs ≤0.8 mg/dL) were associated with higher rate of PR in AS patients treated with anti-TNFα drugs. At 24 months, PR was associated with shorter disease duration (≤36 vs ≥189 months) and higher erythrosedimentation rate (ESR) values (≥45 vs ≤17 mm/h). In male patients lower bath ankylosing spondylitis metrology index (BASMI) (≤2 vs ≥6) and absence of psoriasis were associated with higher PR rate only at 12 months. Other parameters assessed before treatment, such as BASDAI, BASFI, peripheral arthritis, inflammatory bowel disease and uveitis were not associated with PR. Our long-term longitudinal study in a setting of clinical practice showed that inflammatory parameters (i.e. CRP, ESR) and disease duration represent the most important predictive variables to achieve PR with an anti-TNFα treatment.
本研究的目的是评估接受抗TNFα治疗的强直性脊柱炎(AS)患者实现部分缓解(PR)的预测因素。我们纵向纳入了一项多中心研究中的214例AS患者,这些患者根据纽约标准进行分类,接受抗TNFα药物阿达木单抗(ADA)、依那西普(ETA)和英夫利昔单抗(INF)治疗,且至少随访12个月。当以下4个领域中每个领域的评分均<20 mm(在0 - 100 mm视觉模拟量表上)时达到PR:1)患者整体评估(过去一周);2)疼痛(脊柱疼痛);3)功能[通过巴氏强直性脊柱炎功能指数(BASFI)测量];4)炎症[晨僵强度和持续时间的平均值,来自巴氏强直性脊柱炎疾病活动指数(BASDAI)]。214例AS患者(男/女 = 160/54;年龄中位数/范围 = 43.2/19 - 78岁;疾病持续时间中位数/范围 = 96/36 - 189个月)接受了ADA(15.8%)、ETA(28.9%)和INF(55.1%)治疗。在12个月和24个月时,高血清C反应蛋白(CRP)水平(≥2 vs ≤0.8 mg/dL)与接受抗TNFα药物治疗的AS患者更高的PR率相关。在24个月时,PR与较短的疾病持续时间(≤36 vs ≥189个月)和更高的红细胞沉降率(ESR)值(≥45 vs ≤17 mm/h)相关。仅在12个月时,男性患者较低的巴氏强直性脊柱炎测量指数(BASMI)(≤2 vs ≥6)和无银屑病与更高的PR率相关。治疗前评估的其他参数,如BASDAI、BASFI、外周关节炎、炎症性肠病和葡萄膜炎与PR无关。我们在临床实践环境中的长期纵向研究表明,炎症参数(即CRP、ESR)和疾病持续时间是抗TNFα治疗实现PR的最重要预测变量。