Wang Cong-hua, Feng Yuan, Ren Zhen, Yang Xichao, Jia Jun-feng, Rong Meng-yao, Li Xue-yi, Wu Zhen-biao
Department of Clinical Immunology, Xijing Hospital, First Affiliated Hospital of Fourth Military Medical University, Xi'an, People's Republic of China,
Clin Rheumatol. 2015 Jun;34(6):1073-8. doi: 10.1007/s10067-015-2939-5. Epub 2015 Apr 21.
Enthesitis is considered as the primary anatomical lesion in ankylosing spondylitis (AS). We aimed to investigate the potential of ultrasound to detect early changes after TNF-a antagonist therapy of Achilles enthesitis of AS patients. One hundred AS patients with active disease, requiring TNF-a antagonist therapy, were included (etanercept n = 25, infliximab n = 25, adalimumab n = 25, non-biologic disease-modifying antirheumatic drugs (DMARDs) n = 25). Physical examination was performed to evaluate disease activity and detect Achilles enthesitis and/or retrocalcaneal bursitis. Ultrasound of the Achilles enthesitis was performed bilaterally. Follow-up examinations were performed 3 months after the initiation of therapy. Gray scale (GS) scores, Power Doppler (PD) scores, and total additive scores (TS) decreased significantly during TNF-a antagonist therapy but not in traditional non-biologic traditional DMARDs group. The bath ankylosing spondylitis disease activity index (BASDAI), bath ankylosing spondylitis metrology index (BASMI), bath ankylosing spondylitis functional index (BASFI), and Maastricht ankylosing spondylitis enthesitis score (MASES) all showed significant improvements. When three different TNF-a antagonists were analyzed separately, no significant difference was observed in GS, PD, and total scores. Subclinical Achilles enthesitis, detected only with GS ultrasound, is present in a subset of AS patients and a significant improvement can be demonstrated after 3 months of TNF-a antagonist therapy. Doppler ultrasound provides a reliable estimation to monitor the therapeutic response to TNF antagonists in AS patients with Achilles enthesitis. TNF-a antagonists have been shown to be effective in decreasing ultrasound signs of enthesitis after 3 months of therapy in AS patients.
附着点炎被认为是强直性脊柱炎（AS）的主要解剖学病变。我们旨在研究超声检测AS患者跟腱附着点炎在肿瘤坏死因子-α（TNF-α）拮抗剂治疗后早期变化的潜力。纳入了100例有活动性疾病且需要TNF-α拮抗剂治疗的AS患者（依那西普组n = 25、英夫利昔单抗组n = 25、阿达木单抗组n = 25、非生物改善病情抗风湿药（DMARDs）组n = 25）。进行体格检查以评估疾病活动度并检测跟腱附着点炎和/或跟腱后滑囊炎。对双侧跟腱附着点炎进行超声检查。在治疗开始后3个月进行随访检查。在TNF-α拮抗剂治疗期间，灰阶（GS）评分、能量多普勒（PD）评分和总相加评分（TS）显著下降，但在传统非生物DMARDs组中未下降。强直性脊柱炎疾病活动指数（BASDAI）、强直性脊柱炎测量指数（BASMI）、强直性脊柱炎功能指数（BASFI）和马斯特里赫特强直性脊柱炎附着点炎评分（MASES）均显示出显著改善。当分别分析三种不同的TNF-α拮抗剂时，在GS、PD和总分方面未观察到显著差异。仅通过GS超声检测到的亚临床跟腱附着点炎存在于一部分AS患者中，在TNF-α拮抗剂治疗3个月后可显示出显著改善。多普勒超声为监测AS伴跟腱附着点炎患者对TNF拮抗剂的治疗反应提供了可靠的评估。在AS患者中，TNF-α拮抗剂已被证明在治疗3个月后可有效减少附着点炎的超声表现。
