Department of Rheumatology, Amsterdam Rheumatology and Immunology Centre, Amsterdam UMC, Amsterdam, The Netherlands.
Department of Rheumatology, Groene hart ziekenhuis, Gouda, The Netherlands.
J Bone Miner Res. 2019 Jun;34(6):1041-1048. doi: 10.1002/jbmr.3684. Epub 2019 Mar 25.
The aim of this cohort study was to evaluate the long-term effects of TNF inhibitors (TNFis) on BMD and the incidence of vertebral fractures (VFxs) in patients with ankylosing spondylitis (AS). Consecutive patients with active AS with TNFi treatment duration up to 4 years with available DXA scans and spine X-rays were included. BMD (classified according to the WHO criteria for osteoporosis) of the hip and lumbar spine, the VFx (classified as a Genant score >1/>20% height loss), and radiological progression (modified stoke ankylosing spondylitis spinal score [mSASSS]) scores were obtained at baseline and at 4 years of TNFi treatment. Overall, 135 AS patients were included. At baseline, 40.1% of patients had low BMD of the hip and 40.2% of the lumbar spine. This decreased to 38.1% (p = 0.03) with low hip BMD and 25.3% (p < 0.001) of the lumbar spine BMD after 4 years of TNFi treatment. VFxs were present at baseline in 11.1% of the 131 patients, which increased to 19.6% after 4 years of TNFi treatment. A Genant score ≥2, was found at baseline in 3 out of 14 VFx (21.4%) patients, which increased to 7 out of 27 VFx (25.9%) patients after 4 years. All disease activity parameters-the ankylosing spondylitis disease activity scale, the C-reactive protein, the erythrocyte sedimentation rate, and the bath ankylosing spondylitis disease activity index-decreased significantly (p < 0.001). The mean radiological progression (n = 80) increased significantly from a median mSASSS of 4.0 (1.5 to 16.0) at baseline to 6.5 (2.1 to 22.9) after 4 years of TNFi treatment (p < 0.001). Despite the improvement in BMD and the decrease in disease activity, we still found new VFxs, an increase in severity in the number and grade of VFxs, and radiographic progression during 4 years of treatment with TNFis in AS patients with long disease duration. © 2019 American Society for Bone and Mineral Research.
这项队列研究的目的是评估 TNF 抑制剂（TNFis）对强直性脊柱炎（AS）患者骨密度（BMD）和椎体骨折（VFxs）发生率的长期影响。纳入了接受 TNFis 治疗长达 4 年且有可用双能 X 线吸收法（DXA）扫描和脊柱 X 射线的活动性 AS 连续患者。在基线和 TNFis 治疗 4 年后，获得了髋关节和腰椎的 BMD（根据骨质疏松症的世界卫生组织标准分类）、VFx（根据 Genant 评分>1/20%身高损失分类）和放射学进展（改良的斯道克强直性脊柱炎脊柱评分[mSASSS]）评分。总体上，纳入了 135 例 AS 患者。基线时，40.1%的患者髋关节 BMD 低，40.2%的患者腰椎 BMD 低。经过 4 年的 TNFis 治疗后，髋关节 BMD 降至 38.1%（p=0.03），腰椎 BMD 降至 25.3%（p<0.001）。131 例患者中有 11.1%在基线时有 VFx，经过 4 年的 TNFis 治疗后，增加到 19.6%。基线时，14 例 VFx 中有 3 例（21.4%）发现 Genant 评分≥2，经过 4 年的 TNFis 治疗后，增加到 27 例 VFx 中有 7 例（25.9%）。所有疾病活动参数-强直性脊柱炎疾病活动评分、C 反应蛋白、红细胞沉降率和巴斯强直性脊柱炎疾病活动指数-均显著下降（p<0.001）。平均放射学进展（n=80）从基线时的 mSASSS 中位数 4.0（1.5 至 16.0）显著增加到 4 年后的 6.5（2.1 至 22.9）（p<0.001）。尽管 BMD 有所改善，疾病活动度降低，但我们仍发现新的 VFx，VFx 的数量和严重程度增加，以及接受 TNFis 治疗 4 年后 AS 患者的放射学进展。©2019 美国骨骼与矿物质研究协会。
