Capelusnik Dafne, Benavent Diego, van der Heijde Désirée, Landewé Robert, Poddubnyy Denis, van Tubergen Astrid, Falzon Louise, Navarro-Compán Victoria, Ramiro Sofia
Department of Medicine, Care and Public Health Research Institute CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Department of Rheumatology, Instituto de Rehabilitación Psicofísica (IREP), Ciudad de Buenos Aires, Argentina.
Rheumatology (Oxford). 2023 Apr 3;62(4):1398-1409. doi: 10.1093/rheumatology/keac532.
To summarize evidence on the relationship between early treatment (definition based on symptom/disease duration or radiographic damage) and treatment clinical response in patients with SpA.
A systematic literature review was conducted in studies on SpA patients treated with NSAIDs or biological/targeted synthetic DMARDs addressing the impact of symptom/disease duration or presence of radiographic damage on treatment response assessed by any disease activity outcome. For categorical outcomes, relative risk, relative risk ratio and number needed to treat were calculated, and for continuous outcomes, differences in differences, to compare groups stratified based on symptom/disease duration or the presence of radiographic damage.
From the 8769 articles retrieved, 25 were included and 2 added by hand-search, all in axial SpA (axSpA), most of them with low risk of bias. Twenty-one studies compared groups based on symptom duration (n = 6) or disease duration (n = 15) and seven studies based on absence/presence of radiographic damage (two studies used two comparisons). When early axSpA was defined by symptom duration (<5 years) in randomized controlled trials, early treatment was associated with better outcomes in patients with non-radiographic axSpA [n = 2, ASAS40 relative risk ratio 5.24 (95% CI 1.12, 24.41) and 1.52 (0.60, 3.87)] but not in radiographic axSpA (n = 1) [ASAS20 0.96 (0.53-1.73)]. When early axSpA was defined based on disease duration or radiographic damage, no differences were found between groups.
Evidence towards better outcomes in early axSpA is very limited and restricted to non-radiographic axSpA and <5 years symptom duration. When early axSpA is defined based on disease duration or radiographic damage, no differences in response to treatment are found.
总结关于脊柱关节炎（SpA）患者早期治疗（基于症状/疾病持续时间或影像学损伤定义）与治疗临床反应之间关系的证据。
对使用非甾体抗炎药（NSAIDs）或生物制剂/靶向合成改善病情抗风湿药（DMARDs）治疗的SpA患者进行系统文献综述，探讨症状/疾病持续时间或影像学损伤的存在对通过任何疾病活动结局评估的治疗反应的影响。对于分类结局，计算相对风险、相对风险比和治疗所需人数；对于连续结局，计算差异中的差异，以比较基于症状/疾病持续时间或影像学损伤存在进行分层的组。
从检索到的8769篇文章中，纳入25篇并通过手工检索补充2篇，均为轴性SpA（axSpA）相关研究，其中大多数研究偏倚风险较低。21项研究根据症状持续时间（n = 6）或疾病持续时间（n = 15）比较组间情况，7项研究根据影像学损伤的有无进行比较（两项研究使用了两种比较方法）。在随机对照试验中，当早期axSpA根据症状持续时间（<5年）定义时，早期治疗与非放射学axSpA患者的更好结局相关[n = 2，ASAS40相对风险比5.24（95%CI 1.12，24.41）和1.52（0.60，3.87）]，但在放射学axSpA患者中（n = 1）并非如此[ASAS20 0.96（0.53 - 1.73）]。当根据疾病持续时间或影像学损伤定义早期axSpA时，组间未发现差异。
关于早期axSpA有更好结局的证据非常有限，且仅限于非放射学axSpA和症状持续时间<5年的情况。当根据疾病持续时间或影像学损伤定义早期axSpA时，未发现治疗反应存在差异。
