B.S. Koo, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine.
J.S. Oh, MD, PhD, Department of Information Medicine, Big Data Research Center, Asan Medical Center.
J Rheumatol. 2022 Dec;49(12):1328-1334. doi: 10.3899/jrheum.220157. Epub 2022 Jul 15.
To determine the relationship between inflammation and radiographic progression over time in patients with ankylosing spondylitis (AS) attaining a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) of < 4 during tumor necrosis factor inhibitor (TNFi) treatment.
Medical records data of patients with AS with BASDAI scores of < 4 during TNFi treatment were analyzed at 6-month intervals from January 2001 to December 2018. To determine the relationship between the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and C-reactive protein (CRP) over time, we fitted linear mixed models with mSASSS as the response variable, baseline mSASSS and the cumulative sum of CRP with different lag times (6, 12, 18, 24, 30, and 36 months) as fixed effects, and patients as random effects. Associations between mSASSS and the cumulative sum of CRP, or the lag times with the highest beta coefficients, were further investigated with linear mixed models that included additional clinical variables.
A total of 2956 intervals were obtained from 333 patients. Among different lag times, the cumulative sum of log CRP in the previous 18 to 36 months associated with mSASSS showed significant beta coefficients. In the final linear mixed model, the cumulative sum of log CRP in the previous 24 months was significantly associated with mSASSS at 24 months (β 0.04, 95% CI 0.01-0.07, = 0.004).
Remnant inflammation correlates with radiographic progression, even in patients attaining a BASDAI of < 4 during TNFi treatment. CRP is a surrogate marker for radiographic progression despite clinical improvement with TNFi treatment.
确定在肿瘤坏死因子抑制剂（TNFi）治疗期间达到强直性脊柱炎（AS）Bath 强直性脊柱炎疾病活动指数（BASDAI）<4 的患者中，炎症与随时间推移的放射学进展之间的关系。
分析 2001 年 1 月至 2018 年 12 月期间接受 TNFi 治疗期间 BASDAI 评分<4 的 AS 患者的病历数据。为了确定随时间推移改良 Stoke 强直性脊柱炎脊柱评分（mSASSS）和 C 反应蛋白（CRP）之间的关系，我们使用线性混合模型将 mSASSS 作为响应变量，将基线 mSASSS 和 CRP 的累积总和作为固定效应，并将患者作为随机效应，以不同的滞后时间（6、12、18、24、30 和 36 个月）进行拟合。使用线性混合模型进一步研究 mSASSS 与 CRP 的累积总和之间的关联，或与具有最高β系数的滞后时间之间的关联，该模型包含了额外的临床变量。
从 333 名患者中获得了总共 2956 个间隔。在不同的滞后时间中，前 18 至 36 个月的 CRP 对数累积总和与 mSASSS 呈显著的β系数相关。在最终的线性混合模型中，前 24 个月的 CRP 对数累积总和与 24 个月时的 mSASSS 显著相关（β 0.04，95%CI 0.01-0.07，=0.004）。
即使在接受 TNFi 治疗期间达到 BASDAI<4 的患者中，残留炎症也与放射学进展相关。尽管 TNFi 治疗后临床改善，但 CRP 是放射学进展的替代标志物。
