新加坡多民族亚洲人群中强直性脊柱炎与非放射学中轴型脊柱关节炎的比较。
Comparison of ankylosing spondylitis and non-radiographic axial spondyloarthritis in a multi-ethnic Asian population of Singapore.
机构信息
Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
出版信息
Int J Rheum Dis. 2019 Aug;22(8):1506-1511. doi: 10.1111/1756-185X.13603. Epub 2019 May 14.
OBJECTIVES
To compare clinical characteristics, disease activity, patient-reported outcomes and associated comorbidities between patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthitis (nr-axSpA) in a multi-ethnic Asian population of Singapore.
METHODS
We used data from the PREcision medicine in SPONdyloarthritis for Better Outcomes and Disease Remission (PRESPOND) registry in Singapore General Hospital. All patients fulfilled 2009 Assessment in AS International Working Group classification criteria for axial SpA (axSpA). Of these, all AS patients fulfilled the 1984 modified New York criteria. Baseline characteristics, medications, disease activity, patient-reported outcomes and inflammatory markers were recorded using standardized questionnaires.
RESULTS
Two hundred and sixty-two axSpA patients (82% Chinese, 79% male) were included. Mean age (SD) at diagnosis was 32.4 (13.1) years, which was similar between AS and nr-axSpA patients. AS patients were older (mean age 42.7 [13.5] vs 37.4 [13.8] years, P = 0.02), had longer disease duration (mean disease duration 10.9 [8.7] vs 6.4 [4.8] years, P < 0.01), higher Bath Ankylosing Spondylitis Metrology Index (BASMI) (mean BASMI 3.1 [2.3] vs 1.5 [1.5], P < 0.01), more frequently human leukocyte antigen (HLA)-B27 positive (82% vs 68%, P = 0.03), associated with uveitis (33% vs 17%, P = 0.03), and hypertensive (17% vs 0%, P < 0.01) compared to nr-axSpA, respectively. Nr-axSpA patients had higher Bath Ankylosing Spondylitis Global Score (BAS-G) (mean BAS-G 46.9 [16.8] vs 38.6 [20.6], P < 0.01), Bath Ankylosing Spondylitis Disease Activity Index (mean [SD] 4.2 [1.6] vs 3.5 [1.9], P = 0.02) and AS quality of life (ASQoL) (mean ASQoL 4.9 [4.8] vs 3.5 [4.1], P = 0.04) scores compared to AS patients respectively at baseline. Patient global assessment, Bath Ankylosing Spondylitis Functional Index, AS Disease Activity Score - C-reactive protein (CRP), Health Assessment Questionnaire, Short-Form 36 physical component summary and mental component summary were similar in both groups at baseline, as were medications used and mean erythrocyte sedimentation rate and CRP.
CONCLUSIONS
In our multi-ethnic Asian cohort, patients with AS are more likely to be HLA-B27 positive, have uveitis, hypertensive, and have poorer spinal mobility, while nr-axSpA patients tend to experience poorer well-being and quality of life.
目的
比较新加坡多民族亚洲人群中强直性脊柱炎（AS）和非放射学中轴型脊柱关节炎（nr-axSpA）患者的临床特征、疾病活动度、患者报告的结局和相关合并症。
方法
我们使用了新加坡总医院 PREcision medicine in SPONdyloarthritis for Better Outcomes and Disease Remission（PRESPOND）登记处的数据。所有患者均符合 2009 年强直性脊柱炎国际工作组（ASAS）分类标准的中轴型 SpA（axSpA）。其中，所有 AS 患者均符合 1984 年改良的纽约标准。使用标准化问卷记录基线特征、药物、疾病活动度、患者报告的结局和炎症标志物。
结果
共纳入 262 例 axSpA 患者（82%为华人，79%为男性）。诊断时的平均年龄（SD）为 32.4（13.1）岁，AS 和 nr-axSpA 患者的年龄相似。AS 患者年龄更大（平均年龄 42.7 [13.5] vs 37.4 [13.8]岁，P=0.02），疾病病程更长（平均病程 10.9 [8.7] vs 6.4 [4.8]年，P<0.01），Bath 强直性脊柱炎度量指数（BASMI）更高（平均 BASMI 3.1 [2.3] vs 1.5 [1.5]，P<0.01），HLA-B27 阳性率更高（82% vs 68%，P=0.03），更易伴发葡萄膜炎（33% vs 17%，P=0.03），且高血压发生率更高（17% vs 0%，P<0.01）。相比之下，nr-axSpA 患者的 Bath 强直性脊柱炎总体评分（BAS-G）更高（平均 BAS-G 46.9 [16.8] vs 38.6 [20.6]，P<0.01），Bath 强直性脊柱炎疾病活动指数（平均[SD] 4.2 [1.6] vs 3.5 [1.9]，P=0.02）和强直性脊柱炎生活质量（ASQoL）评分（平均 ASQoL 4.9 [4.8] vs 3.5 [4.1]，P=0.04）均更高。
结论
在我们的多民族亚洲队列中，AS 患者更有可能 HLA-B27 阳性、伴发葡萄膜炎、高血压，且脊柱活动度更差，而 nr-axSpA 患者的生活质量和幸福感更差。
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