Leiden University Medical Center, Leiden, The Netherlands, and Universidade Nova de Lisboa, Lisboa, Portugal.
Leiden University Medical Center, Leiden, The Netherlands, and Zuyderland Medical Center, Heerlen, The Netherlands.
Arthritis Rheumatol. 2021 Jul;73(7):1211-1219. doi: 10.1002/art.41667. Epub 2021 May 25.
To investigate whether tumor necrosis factor inhibitors (TNFi) impact spinal radiographic progression in patients with axial spondyloarthritis (SpA) and whether this is coupled to their effect on inflammation.
Patients with axial SpA fulfilling the modified New York criteria were included in a prospective cohort (the ALBERTA Follow Up Research Cohort in Ankylosing Spondylitis Treatment). Spine radiographs, performed every 2 years for up to 10 years, were scored by 2 central readers, using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The indirect effect of TNFi on mSASSS was evaluated with generalized estimating equations by testing the interaction between TNFi and Ankylosing Spondylitis Disease Activity Score (ASDAS) at the start of each 2-year interval (t). If significant, the association between ASDAS at t and mSASSS at the end of the interval (t+1) was assessed in 1) patients treated with TNFi at all visits, 2) patients treated with TNFi at some visits, and 3) patients who were never treated with TNFi. In addition, the association between TNFi at t and mSASSS at t+1 (adjusting for ASDAS at t) was also tested (direct effect).
In total, 314 patients were included. A gradient was seen for the effect of ASDAS at t on mSASSS at t+1 (interaction P = 0.10), with a higher progression in patients never treated with TNFi (β = 0.41 [95% confidence interval (95% CI) 0.13, 0.68]) compared to those continuously treated (β = 0.16 [95% CI 0.00, 0.31]) (indirect effect). However, TNFi also directly slowed progression, as treated patients had on average an mSASSS 0.85 units lower at t+1 compared to untreated patients (β = -0.85 [95% CI -1.35, -0.35]).
Our findings indicate that TNFi reduce spinal radiographic progression in patients with radiographic axial SpA, which might be partially uncoupled from their effects on inflammation as measured by the ASDAS.
探讨肿瘤坏死因子抑制剂（TNFi）是否会影响中轴型脊柱关节炎（SpA）患者的脊柱放射学进展，以及这是否与其对炎症的作用有关。
符合改良纽约标准的中轴型 SpA 患者被纳入前瞻性队列（安贝司特治疗后脊柱关节炎随访研究队列）。每 2 年进行一次脊柱放射学检查，最长达 10 年，由 2 位中心阅片者使用改良 Stoke 强直性脊柱炎脊柱评分（mSASSS）进行评分。通过在每 2 年间隔的开始时检验 TNFi 与强直性脊柱炎疾病活动度评分（ASDAS）之间的交互作用（t），用广义估计方程评估 TNFi 对 mSASSS 的间接影响。如果有统计学意义，则在以下情况下评估 ASDAS 在 t 时与间隔结束时的 mSASSS（t+1）之间的相关性：1）所有就诊时均接受 TNFi 治疗的患者；2）某些就诊时接受 TNFi 治疗的患者；3）从未接受 TNFi 治疗的患者。此外，还测试了在 t 时 TNFi 与 t+1 时的 mSASSS 之间的相关性（调整 t 时的 ASDAS）（直接影响）。
共纳入 314 例患者。ASDAS 在 t 时对 mSASSS 在 t+1 时的影响呈梯度分布（交互作用 P = 0.10），从未接受 TNFi 治疗的患者进展更明显（β = 0.41 [95%置信区间（95%CI）0.13，0.68]），而连续接受治疗的患者（β = 0.16 [95%CI 0.00，0.31]）（间接影响）。然而，TNFi 也直接减缓了进展，因为治疗组患者在 t+1 时的 mSASSS 平均比未治疗组低 0.85 个单位（β = -0.85 [95%CI -1.35，-0.35]）。
我们的研究结果表明，TNFi 可降低影像学中轴型 SpA 患者的脊柱放射学进展，这可能与其通过 ASDAS 测量的对炎症的作用部分脱钩。
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