Section of Rheumatology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
Division of Arthritis & Rheumatic diseases, Oregon Health & Science University, Portland, OR, USA.
Nat Rev Rheumatol. 2022 Apr;18(4):205-216. doi: 10.1038/s41584-022-00761-z. Epub 2022 Mar 10.
Diagnosis and management of axial spondyloarthritis (axSpA) has vastly improved over the past two decades. With advances in the discernment of immunopathogenesis of this disease, new therapies have become available, which are associated with substantial improvement in symptoms, signs and quality of life. The four broad categories of approved treatment options are physical therapy and exercise (which have been known to be beneficial for millennia), NSAIDs (since the 1950s), TNF inhibitors (first FDA approval in 2003) and IL-17 inhibitors (first FDA approval in 2016). In addition, there have been a host of new developments in the axSpA field, including new treatment guidelines, the FDA approval of three biologic DMARDs to treat non-radiographic axSpA, the FDA and EMA approval of Janus kinase (JAK) inhibitors for ankylosing spondylitis, new data on the effect of biologic DMARDs on structural progression in ankylosing spondylitis, strategy trials on tapering or stopping TNF inhibitors in patients in remission, trials of treat-to-target strategy in axSpA, and several new molecules in phase III studies. This Review explores the developments in the management of axSpA.
在过去的二十年中，轴向脊柱关节炎（axSpA）的诊断和治疗有了很大的改进。随着对这种疾病免疫发病机制的认识的提高，新的治疗方法已经出现，这与症状、体征和生活质量的显著改善有关。已批准的四类广泛的治疗选择包括物理治疗和运动（这在几千年来一直被证明是有益的）、非甾体抗炎药（自 20 世纪 50 年代以来）、TNF 抑制剂（2003 年首次获得美国食品和药物管理局批准）和 IL-17 抑制剂（2016 年首次获得美国食品和药物管理局批准）。此外，axSpA 领域还出现了许多新的发展，包括新的治疗指南、美国食品和药物管理局批准三种生物 DMARD 治疗非放射性 axSpA、美国食品和药物管理局和欧洲药品管理局批准 JAK 抑制剂治疗强直性脊柱炎、生物 DMARD 对强直性脊柱炎结构进展影响的新数据、缓解期患者停止或停止 TNF 抑制剂的减量试验、axSpA 的达标治疗策略试验以及三期研究中的几种新分子。这篇综述探讨了 axSpA 的治疗进展。
