轴向银屑病关节炎与伴有和不伴有并发银屑病的强直性脊柱炎是否不同？
Is axial psoriatic arthritis distinct from ankylosing spondylitis with and without concomitant psoriasis?
机构信息
Krembil Research Institute, Toronto Western Hospital, University Health Network.
Institute of Medical Science, University of Toronto, Toronto.
出版信息
Rheumatology (Oxford). 2020 Jun 1;59(6):1340-1346. doi: 10.1093/rheumatology/kez457.
OBJECTIVE
The aim of this study was to compare patients with ankylosing spondylitis with psoriasis (ASP) and without psoriasis (AS), to axial PsA (axPsA) patients.
METHODS
Two adult cohorts were recruited from the AS clinic: ASP and AS. These two cohorts were compared with two adult cohorts recruited from the PsA clinic: axPsA (radiographic sacroiliitis: ⩾bilateral grade 2 or unilateral grade 3 or 4); and Peripheral PsA. All patients were followed prospectively according to the same protocol. The demographic, clinical and radiographic variables were compared. Adjusted means were used to account for varying intervals between visits. A logistic regression was performed and adjusted for follow-up duration.
RESULTS
There were 477 axPsA patients, 826 peripheral PsA, 675 AS and 91 ASP patients included. AS patients were younger (P < 0.001), more male and HLA-B*27 positive (76%, 72% vs 64%, P ⩽ 0.001, 82%, 75%, vs 19%, P = 0.001). They had more back pain at presentation (90%, 92% vs 19%, P = 0.001), worse axial disease activity scores (bath ankylosing spondylitis disease activity index: 4.1, 3.9 vs 3.5 P = 0.017), worse back metrology (bath ankylosing spondylitis metrology index: 2.9, 2.2 vs 1.8, P < 0.001), worse physician global assessments (2.4, 2.2 vs 2.1, P < 0.001), were treated more with biologics (29%, 21% vs 7%, P = 0.001) and had a higher grade of sacroiliitis (90%, 84% vs 51%, P < 0.001). Similar differences were detected in the comparison of ASP to axPsA and in a regression model.
CONCLUSION
AS patients, with or without psoriasis, seem to be different demographically, genetically, clinically and radiographically from axPsA patients. axPsA seems to be a distinct entity.
目的
本研究旨在比较强直性脊柱炎合并银屑病（ASP）患者与单纯强直性脊柱炎（AS）患者、与放射学中轴型银屑病关节炎（axPsA）患者的差异。
方法
从强直性脊柱炎门诊招募了两个成年队列：ASP 和 AS。将这两个队列与从银屑病关节炎门诊招募的两个成年队列进行比较：axPsA（放射学骶髂关节炎：双侧 2 级或单侧 3 级或 4 级；外周型银屑病关节炎）；和外周型银屑病关节炎。所有患者均根据相同的方案进行前瞻性随访。比较了人口统计学、临床和影像学变量。使用调整均值来考虑就诊间隔的不同。进行了逻辑回归，并根据随访时间进行了调整。
结果
共纳入 477 例 axPsA 患者、826 例外周型银屑病关节炎患者、675 例 AS 患者和 91 例 ASP 患者。AS 患者更年轻（P<0.001），男性比例和 HLA-B*27 阳性率更高（76%、72% vs 64%，P ⩽ 0.001；82%、75% vs 19%，P=0.001）。他们在就诊时更常出现背痛（90%、92% vs 19%，P=0.001），中轴疾病活动评分更高（bath 强直性脊柱炎疾病活动指数：4.1、3.9 vs 3.5，P=0.017），背部测量指标更差（bath 强直性脊柱炎测量指数：2.9、2.2 vs 1.8，P<0.001），医生整体评估更差（2.4、2.2 vs 2.1，P<0.001），接受生物制剂治疗的比例更高（29%、21% vs 7%，P=0.001），骶髂关节炎严重程度更高（90%、84% vs 51%，P<0.001）。在 ASP 与 axPsA 的比较中以及回归模型中均发现了类似的差异。
结论
有或无银屑病的 AS 患者在人口统计学、遗传学、临床和影像学方面似乎与 axPsA 患者不同。axPsA 似乎是一种独特的实体。
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