前瞻性纵向银屑病关节炎队列中疾病修饰抗风湿药物对肌腱端炎的疗效。

Effectiveness of Disease-Modifying Antirheumatic Drugs for Enthesitis in a Prospective Longitudinal Psoriatic Arthritis Cohort.

机构信息

A.J. Mathew, DNB, DM, Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada, The Copenhagen Center for Arthritis and Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India.

M. Sutton, MSc, D. Pereira, MSc, Centre for Prognosis Studies in the Rheumatic Diseases, Psoriatic Arthritis Program, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.

出版信息

J Rheumatol. 2022 Sep;49(9):1020-1025. doi: 10.3899/jrheum.211231. Epub 2022 Jun 1.

DOI:10.3899/jrheum.211231

PMID:35649547

Abstract

OBJECTIVE

Our objective was to assess the effectiveness of conventional and targeted disease-modifying antirheumatic drugs (cDMARDs and tDMARDs, respectively) in treating enthesitis in psoriatic arthritis (PsA).

METHODS

Patients with active enthesitis, defined as ≥ 1 tender entheses (of the 29 enthesis sites included in the Spondyloarthritis Research Consortium of Canada Enthesitis Index, the Leeds Enthesitis Index, and the Maastricht Ankylosing Spondylitis Enthesitis Score), who were enrolled in a large PsA cohort were included. Medications at baseline were classified into 3 mutually exclusive categories: (1) no treatment or nonsteroidal antiinflammatory drugs (NSAIDs) only; (2) cDMARDs ± NSAIDs; and (3) tDMARDs ± cDMARDs/NSAIDs. Complete resolution of enthesitis (no tender enthesis) at 12 months was the primary outcome. Logistic regression models were developed to determine the association between medication category and enthesitis resolution.

RESULTS

Of the 1270 patients studied, 628 (49.44%) had enthesitis. Of these, 526 patients (51.71% males; mean [SD] age 49.02 [13.12] years; mean enthesitis score 2.13 [2.16]; median enthesitis score 2 [IQR 1-2]), with adequate follow-up were analyzed. Complete resolution of enthesitis was noted in 453 (86.12%) patients, within a mean period of 8.73 (3.48) months from baseline. In the regression analysis, though not significant, DMARDs (categories II and III) had higher odds ratios (ORs) compared to category 1 for resolution of enthesitis. Enthesitis resolution was associated with lower joint activity (OR 0.97, 95% CI 0.95-0.99; = 0.01) and male sex (OR 1.66, 95% CI 0.97-2.84; = 0.06).

CONCLUSION

Resolution of enthesitis was observed in 86% of patients in an observational setting regardless of the medication used. Future effectiveness studies may warrant evaluation of enthesitis using advanced imaging.

摘要

目的

我们的目的是评估常规和靶向疾病修饰抗风湿药物（分别为 cDMARDs 和 tDMARDs）治疗银屑病关节炎（PsA）肌腱端炎的疗效。

方法

纳入了一项大型 PsA 队列研究中患有活动性肌腱端炎的患者，定义为≥ 1 个压痛肌腱端（包括加拿大脊柱关节炎研究协会肌腱端炎指数、利兹肌腱端炎指数和马斯特里赫特强直性脊柱炎肌腱端炎评分中的 29 个肌腱端部位）。基线时的药物分为 3 个互斥类别：（1）无治疗或非甾体抗炎药（NSAIDs）；（2）cDMARDs ± NSAIDs；和（3）tDMARDs ± cDMARDs/NSAIDs。12 个月时完全缓解肌腱端炎（无压痛肌腱端）是主要结局。采用逻辑回归模型确定药物类别与肌腱端炎缓解之间的关联。

结果

在研究的 1270 名患者中，628 名（49.44%）患有肌腱端炎。其中，526 名患者（51.71%为男性；平均[标准差]年龄 49.02[13.12]岁；平均肌腱端炎评分 2.13[2.16]；中位数肌腱端炎评分 2[IQR 1-2]），在基线时具有足够的随访时间，被纳入分析。453 名（86.12%）患者在平均 8.73（3.48）个月内完全缓解了肌腱端炎。在回归分析中，尽管不显著，但与第 1 类相比，DMARDs（第 2 类和第 3 类）的缓解肌腱端炎的比值比（OR）更高。肌腱端炎的缓解与较低的关节活动度（OR 0.97，95%置信区间 0.95-0.99； = 0.01）和男性性别（OR 1.66，95%置信区间 0.97-2.84； = 0.06）相关。