在轴性脊柱关节炎中，使用 TNF 抑制剂治疗可减缓骶髂关节的放射学进展：来自 SCQM 登记处的 12 年数据。
Sacroiliac joint radiographic progression in axial spondyloarthritis is retarded by the therapeutic use of TNF inhibitors: 12-year data from the SCQM registry.
机构信息
Department of Rheumatology, University of Zurich, Zurich, Switzerland.
DataScience, SCQM Foundation, Zurich, Switzerland.
出版信息
RMD Open. 2022 Oct;8(2). doi: 10.1136/rmdopen-2022-002551.
OBJECTIVES
To analyse the effect of tumour necrosis factor inhibitors (TNFi) on sacroiliac joint (SIJ) radiographic progression in axial spondyloarthritis (axSpA).
METHODS
Patients with axSpA in the Swiss Clinical Quality Management cohort with up to 12 years of follow-up and radiographic assessments every 2 years were included. SIJs were scored by two readers according to the modified New York criteria blinded to chronology. The relationship between TNFi use before or during a 2-year radiographic interval and SIJ progression was investigated using generalised estimating equation models with adjustment for potential confounding. Progression was defined as worsening of ≥1 grade in ≥1 SIJ and ignoring a change from 0 to 1 over 2 years, if both readers agreed. A third reading of radiographs was integrated in sensitivity analyses.
RESULTS
A total of 515 patients with axSpA contributed to data for 894 radiographic intervals (24 progression events). In patients with complete covariate data, prior use of TNFi reduced the odds of progression (OR 0.21, 95% CI 0.07 to 0.65). A comparable effect was found for use of TNFi for ≥1 year within a 2-year radiographic interval (OR 0.21, 95% CI 0.08 to 0.55). The inhibitory impact of TNFi was confirmed if progression was demonstrated in 2/3 readings: OR 0.50, 95% CI 0.28 to 0.89 and OR 0.46, 95% CI 0.27 to 0.78 for TNFi treatment before and for ≥1 year within the interval, respectively.
CONCLUSION
TNFi are associated with deceleration of SIJ radiographic progression in patients with axSpA if treatment is continued for ≥1 year.
目的
分析肿瘤坏死因子抑制剂（TNFi）对中轴型脊柱关节炎（axSpA）骶髂关节（SIJ）放射学进展的影响。
方法
纳入瑞士临床质量管理队列中具有长达 12 年随访和每 2 年进行一次放射学评估的 axSpA 患者。SIJ 由两位读者根据改良纽约标准进行评分，评分时读者对时间顺序不知情。使用广义估计方程模型，通过调整潜在混杂因素，调查 TNFi 在 2 年放射学间隔内使用或使用前与 SIJ 进展之间的关系。进展定义为≥1 个 SIJ 恶化≥1 级，且如果两位读者均同意，忽略 2 年内从 0 到 1 的变化。在敏感性分析中整合了第三张 X 光片的阅读。
结果
共有 515 名 axSpA 患者为 894 个放射学间隔（24 个进展事件）的数据提供了资料。在具有完整协变量数据的患者中，TNFi 的既往使用降低了进展的可能性（OR 0.21，95%CI 0.07 至 0.65）。在 2 年放射学间隔内使用 TNFi≥1 年也发现了类似的效果（OR 0.21，95%CI 0.08 至 0.55）。如果在 2/3 次阅读中显示出进展，则证实了 TNFi 的抑制作用：TNFi 治疗前的 OR 为 0.50（95%CI 0.28 至 0.89），间隔内使用≥1 年的 OR 为 0.46（95%CI 0.27 至 0.78）。
结论
如果 TNFi 治疗持续≥1 年，axSpA 患者的 SIJ 放射学进展速度会减慢。
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