Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, 1-10 Ami-Dong, Seo-Gu, Busan, 49241, Republic of Korea.
Eur Spine J. 2019 Apr;28(4):649-657. doi: 10.1007/s00586-019-05912-7. Epub 2019 Feb 11.
Limited data are available on the relationship between treatment agents and sagittal balance in ankylosing spondylitis (AS). We investigated radiological features related to treatment agents and compared sagittal balance between patients treated with anti-tumor necrosis factor-α (anti-TNF-α) and those treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and sulfasalazine (SSZ).
We prospectively enrolled 133 consecutive AS patients. Patients were eligible for the trial if they were under medical treatment with the same treatment agents for at least 1 year. All patients were treated initially with NSAIDs and SSZ. Sixty-nine patients achieved an excellent pain control outcome with these agents (group A). Sixty-four patients who reported of intractable low back pain were switched to anti-TNF-α treatment (group B). Twelve radiographic parameters were measured. Clinical outcome was assessed with the Bath AS Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). All parameters were measured at enrolment, upon changing treatment agents, and every 6 months during follow-up.
The mean ESR, CRP, BASDAI, and thoracic kyphosis at baseline were significantly higher in group B. After treatment, group B had significantly higher lumbar lordosis (LL) and significantly better clinical outcomes. Correlation analysis revealed significant relationships between radiologic parameters and BASDAI. On multiple regression analysis, LL was a significant predictor of BASDAI.
This study demonstrated a clear association between treatment agents and radiologic parameters in AS. Anti-TNF-α treatment improved LL with improvement in clinical outcomes. Lumbar lordosis was a significant predictor of clinical outcome in AS patients treated with anti-TNF-α. These slides can be retrieved under Electronic Supplementary Material.
关于强直性脊柱炎（AS）治疗药物与矢状位平衡之间的关系，相关数据有限。我们研究了与治疗药物相关的影像学特征，并比较了接受肿瘤坏死因子-α（anti-TNF-α）治疗与非甾体抗炎药（NSAIDs）和柳氮磺胺吡啶（SSZ）治疗的患者之间的矢状位平衡。
我们前瞻性纳入了 133 例连续的 AS 患者。如果患者接受相同治疗药物治疗至少 1 年，则符合试验条件。所有患者最初均接受 NSAIDs 和 SSZ 治疗。69 例患者（A 组）对这些药物具有良好的止痛效果。64 例报告难治性腰痛的患者改用 anti-TNF-α 治疗（B 组）。测量了 12 项影像学参数。使用 Bath AS 疾病活动指数（BASDAI）、红细胞沉降率（ESR）和 C 反应蛋白（CRP）评估临床结果。所有参数均在入组时、更换治疗药物时以及随访期间每 6 个月测量一次。
B 组的平均 ESR、CRP、BASDAI 和胸腰椎后凸在基线时显著更高。治疗后，B 组的腰椎前凸（LL）显著更高，临床结果显著更好。相关性分析显示影像学参数与 BASDAI 之间存在显著关系。多元回归分析显示，LL 是 BASDAI 的显著预测因素。
本研究表明 AS 中治疗药物与影像学参数之间存在明显关联。anti-TNF-α 治疗改善了 LL，同时改善了临床结果。在接受 anti-TNF-α 治疗的 AS 患者中，LL 是临床结果的显著预测因素。这些幻灯片可在电子补充材料中检索。
