Maas Fiona, Arends Suzanne, Brouwer Elisabeth, Essers Ivette, van der Veer Eveline, Efde Monique, van Ooijen Peter M A, Wolf Rinze, Veeger Nic J G M, Bootsma Hendrika, Wink Freke R, Spoorenberg Anneke
University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
University Medical Center Groningen, University of Groningen, Groningen, and Medical Center Leeuwarden, Leeuwarden, The Netherlands.
Arthritis Care Res (Hoboken). 2017 Jul;69(7):1011-1019. doi: 10.1002/acr.23097. Epub 2017 Jun 9.
To evaluate the course of spinal radiographic progression for up to 8 years of followup in a large cohort of ankylosing spondylitis (AS) patients treated with tumor necrosis factor (TNF) inhibitors.
Consecutive patients from the Groningen Leeuwarden AS cohort starting TNF inhibitors between 2004 and 2012 were included. Baseline and biannual radiographs were randomized with radiographs of TNF-naive AS patients and scored in chronologic order according to modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The course of radiographic progression (linear or nonlinear) was investigated using generalized estimating equations. Primary analysis was performed in patients with complete data over 4, 6, and 8 years of followup. Sensitivity analysis was performed after single linear imputation of missing radiographic data and after adjusting for patient characteristics with possible influence on radiographic progression.
At baseline, median mSASSS of 210 included AS patients was 2.8 (interquartile range 0.0-12.0), mean ± SD mSASSS 10.0 ± 15.5. During the first 4 years, radiographic progression followed a linear course (estimated mean progression rate was 1.7 for 0-2 and 2-4 years). A deflection from a linear course was found in patients with complete and imputed data over 6 and 8 years. The estimated mean 2-year progression rate reduced from 2.3 to 0.8 in patients with complete 8-year data. The same pattern was found after adjustment for baseline mSASSS scores, presence of syndesmophytes, sex, HLA-B27 status, age, symptom duration, smoking duration, body mass index, disease activity, and nonsteroidal antiinflammatory drug use.
This observational cohort study in AS patients receiving long-term TNF inhibitors showed a reduction in spinal radiographic progression after more than 4 years of followup.
评估一大群接受肿瘤坏死因子（TNF）抑制剂治疗的强直性脊柱炎（AS）患者长达8年随访期内脊柱影像学进展情况。
纳入2004年至2012年间开始使用TNF抑制剂的格罗宁根-吕伐登AS队列的连续患者。将基线和每半年的X线片与未使用过TNF的AS患者的X线片随机分组，并根据改良斯托克强直性脊柱炎脊柱评分（mSASSS）按时间顺序评分。使用广义估计方程研究影像学进展过程（线性或非线性）。对随访4年、6年和8年有完整数据的患者进行初步分析。在对缺失的影像学数据进行单一线性插补后以及在调整可能影响影像学进展的患者特征后进行敏感性分析。
基线时，纳入的210例AS患者的mSASSS中位数为2.8（四分位间距0.0 - 12.0），mSASSS均值±标准差为10.0±15.5。在最初4年，影像学进展呈线性过程（0至2年和2至4年的估计平均进展率为1.7）。在随访6年和8年有完整和插补数据的患者中发现偏离线性过程。在有完整8年数据的患者中，估计的平均2年进展率从2.3降至0.8。在调整基线mSASSS评分、骨桥形成情况、性别、HLA - B27状态、年龄、症状持续时间、吸烟时间、体重指数、疾病活动度和非甾体抗炎药使用情况后发现了相同模式。
这项对接受长期TNF抑制剂治疗的AS患者的观察性队列研究显示，随访超过4年后脊柱影像学进展有所减少。
