肿瘤坏死因子抑制剂与非甾体抗炎药治疗对早期强直性脊柱炎放射学进展的影响：与治疗期间炎症控制的关系。
Impact of Tumor Necrosis Factor Inhibitor Versus Nonsteroidal Antiinflammatory Drug Treatment on Radiographic Progression in Early Ankylosing Spondylitis: Its Relationship to Inflammation Control During Treatment.
机构信息
Seoul National University College of Medicine, Seoul, Republic of Korea.
Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
出版信息
Arthritis Rheumatol. 2019 Jan;71(1):82-90. doi: 10.1002/art.40661. Epub 2018 Nov 12.
OBJECTIVE
To investigate the impact of tumor necrosis factor inhibitor (TNFi) treatment and inflammation control on radiographic progression in early ankylosing spondylitis (AS) over 4 years.
METHODS
We included a total of 215 patients with early AS (symptom duration <10 years) treated with TNFi (the TNFi group; n = 135) or with nonsteroidal antiinflammatory drugs (NSAIDs) (the control group; n = 80). Two blinded readers assessed radiographic progression using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Inflammation control was inferred from C-reactive protein (CRP) levels time-averaged between 2 radiologic assessments. Linear mixed modeling was used to estimate mSASSS changes over radiographic intervals as well as the impact of clinical factors on outcomes.
RESULTS
The TNFi group had longer disease duration, a higher baseline CRP level, and a higher Bath Ankylosing Spondylitis Disease Activity Index than did controls. The time-averaged CRP level over radiographic intervals was lower with TNFi treatment than with NSAID treatment (mean ± SD 0.27 ± 0.30 mg/dl versus 0.61 ± 0.68 mg/dl; P < 0.001). Overall, mean ± SD mSASSS change over the 2-year interval was 1.30 ± 2.97 units. In the multivariable model adjusted for age, smoking status, baseline CRP level, and the presence of syndesmophytes at baseline, the TNFi group showed less mSASSS change over the 2-year interval (β = -0.90 [95% confidence interval {95% CI} -1.51, -0.29]). However, when a time-averaged CRP level was additionally included, it significantly influenced the mSASSS change (β = 1.02 [95% CI 0.32, 1.71]), decreasing the estimated group difference (β = -0.52 [95% CI -1.17, 0.14]). NSAID indices of both groups were not associated with either time-averaged CRP levels or mSASSS changes.
CONCLUSION
Effective suppression of inflammation by TNFi treatment decreases radiographic progression in early AS.
目的
探究肿瘤坏死因子抑制剂（TNFi）治疗和炎症控制对病程不足 10 年的早期强直性脊柱炎（AS）患者在 4 年内放射学进展的影响。
方法
我们纳入了 215 名接受 TNFi（TNFi 组，n=135）或非甾体抗炎药（NSAIDs）（对照组，n=80）治疗的早期 AS 患者。两名盲法读片者采用改良的 Stoke 强直性脊柱炎脊柱评分（mSASSS）评估放射学进展。通过两次放射学评估之间平均的 C 反应蛋白（CRP）水平推断炎症控制情况。线性混合模型用于评估放射学间隔内 mSASSS 的变化以及临床因素对结果的影响。
结果
TNFi 组的病程较长，基线 CRP 水平较高，Bath 强直性脊柱炎疾病活动指数（BASDAI）较高。与 NSAIDs 治疗相比，TNFi 治疗的放射学间隔内平均 CRP 水平较低（0.27±0.30mg/dl 比 0.61±0.68mg/dl；P＜0.001）。总体而言，2 年间隔内 mSASSS 的平均变化为 1.30±2.97 个单位。在调整年龄、吸烟状态、基线 CRP 水平和基线时存在骨桥的多变量模型中，TNFi 组在 2 年间隔内 mSASSS 变化较小（β=-0.90[95%置信区间{95%CI}为-1.51，-0.29]）。然而，当额外纳入平均 CRP 水平时，它显著影响 mSASSS 的变化（β=1.02[95%CI 为 0.32，1.71]），从而降低了组间差异的估计值（β=-0.52[95%CI 为-1.17，0.14]）。两组的 NSAID 指标均与平均 CRP 水平或 mSASSS 变化无关。
结论
TNFi 治疗有效抑制炎症可减少早期 AS 的放射学进展。
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