Kiltz U, Wiatr T, Kiefer D, Baraliakos X, Braun J
Rheumazentrum Ruhrgebiet, Claudiusstr. 45, 44649, Herne, Deutschland.
Ruhr Universität Bochum, Bochum, Deutschland.
Z Rheumatol. 2024 Mar;83(2):153-159. doi: 10.1007/s00393-022-01241-1. Epub 2022 Jul 28.
Multimodal rheumatologic complex treatment (MRCT) is based on an acute inpatient treatment concept for patients with clinically relevant functional impairments and exacerbation of pain, which are caused by rheumatic and musculoskeletal diseases. Patients with axial spondylarthritis (axSpA) including ankylosing spondylarthritis (AS) often suffer from such health problems. Regular movement exercises and physical therapy measures are an important pillar of treatment management. The ASAS Health Index (ASAS-HI) can be used to document the global functional ability and health of axSpA patients. The selectivity of the ASAS HI for nonpharmacological treatment changes has so far not yet been proven.
Evaluation of the MRCT and ASAS HI for nonpharmacological treatment measures of patients with axSpA carried out in the Ruhr Area Rheumatism Center. The primary endpoint was an improvement of the ASDAS≥ 1.1. It was assumed that > 25% of the patients would achieve this threshold.
Consecutively included patients with active axSpA and relevant functional impairments received inpatient treatment for 14 days during MRCT. On days 1 (V1) and 14 (V2) all patients completed questionnaires on pain (NRS), disease activity (BASDAI, ASDAS) and function (BASFI, ASAS HI). The clinical examination was carried out using BASMI and measurement of C‑reactive protein (CRP) at both times.
The 66 prospectively included patients had an average age of 47.2 years (SD 14.2 years), a duration of symptoms of ca. 20 years, 65.3% were male, 75% were positive for HLA B27 and CRP was elevated in 41.3%. The disease activity at V1 was elevated: BASDAI 5.6 (1.8), ASDAS 3.1 (0.9), whereas functional ability and mobility were reduced: BASFI 3.5 (1.8), BASMI 5.6 (2.1), ASAS-HI 8.4 (3.4). During the course the global patient verdict improved (NRS 0-10) from 6.9 (1.7) at V1 to 4.8 (1.8) at V2 and the pain from 6.9 (1.9) to 4.7 (2.0) (all p < 0.001). The disease activity also decreased at V2: BASDAI 4.1 (1.9), ASDAS 2.4 (1.0), function and mobility were also improved: BASFI 4.3 (2.4), BASMI 2.7 (1.6), ASAS HI 6.5 (3.8) (all p < 0.001).
In this study the effectiveness of a 2‑week MRCT according to OPS 8-983.1 with respect to important patient-centered outcomes (PCO) could be proven and the results of previous studies could be confirmed. In this context ASAS-HI was also sensitive to change.
多模式风湿综合治疗（MRCT）基于针对因风湿性和肌肉骨骼疾病导致临床相关功能障碍和疼痛加剧的患者的急性住院治疗理念。包括强直性脊柱炎（AS）在内的轴性脊柱关节炎（axSpA）患者经常遭受此类健康问题。规律的运动锻炼和物理治疗措施是治疗管理的重要支柱。ASAS健康指数（ASAS-HI）可用于记录axSpA患者的整体功能能力和健康状况。迄今为止，尚未证实ASAS HI对非药物治疗变化的选择性。
评估在鲁尔地区风湿病中心对axSpA患者采取的MRCT和ASAS HI非药物治疗措施。主要终点是ASDAS改善≥1.1。假设超过25%的患者将达到该阈值。
连续纳入有活动性axSpA且有相关功能障碍的患者，在MRCT期间接受14天的住院治疗。在第1天（V1）和第14天（V2），所有患者完成关于疼痛（数字评分量表）、疾病活动度（巴斯强直性脊柱炎疾病活动指数、ASDAS）和功能（巴斯强直性脊柱炎功能指数、ASAS HI）的问卷。两次均使用巴斯强直性脊柱炎脊柱测量指数进行临床检查并测量C反应蛋白（CRP）。
前瞻性纳入的66例患者平均年龄为47.2岁（标准差14.2岁），症状持续时间约20年，65.3%为男性，75% HLA B27呈阳性，41.3%的患者CRP升高。V1时疾病活动度升高：巴斯强直性脊柱炎疾病活动指数5.6（1.8），ASDAS 3.1（0.9），而功能能力和活动能力降低：巴斯强直性脊柱炎功能指数3.5（1.8），巴斯强直性脊柱炎脊柱测量指数5.6（2.1），ASAS-HI 8.4（3.4）。在此过程中，患者整体评价改善（数字评分量表0-10），从V1时的6.9（1.7）改善至V2时的4.8（1.8），疼痛从6.9（1.9）改善至4.7（2.0）（所有p<0.001）。V2时疾病活动度也降低：巴斯强直性脊柱炎疾病活动指数4.1（1.9），ASDAS 2.4（1.0），功能和活动能力也得到改善：巴斯强直性脊柱炎功能指数4.3（2.4），巴斯强直性脊柱炎脊柱测量指数2.7（1.6），ASAS HI 6.5（3.8）（所有p<0.001）。
在本研究中，可证明按照OPS 8-983.1进行的为期2周的MRCT对于重要的以患者为中心的结局（PCO）是有效的，并且可以证实先前研究的结果。在此背景下，ASAS-HI对变化也很敏感。
