Eder Lihi, Mathew Ashish J, Carron Philippe, Bertheussen Heidi, Cañete Juan D, Azem May, Delle Sedie Andrea, Salvarani Carlo, Ranza Roberto, Elliott Ashley, Turkiewicz Anthony, de Toledo Ricardo Acayaba, Bukulmez Hulya, Stoenoiu Maria S, Mandelin Arthur M, Koehm Michaela, Lindsay Chris A, Siegel Evan, Mease Philip J
L. Eder, MD, PhD, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada;
A.J. Mathew, MBBS, DNB, DM, The Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark, and Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India.
J Rheumatol. 2023 Feb;50(2):258-264. doi: 10.3899/jrheum.220312. Epub 2022 Nov 1.
Enthesitis is a key pathological and clinical feature of psoriatic arthritis (PsA) in children and adults. Enthesitis is typically assessed clinically using several validated enthesitis scoring systems that have been used in clinical trials. Enthesitis treatment response has been reported as change in the total enthesitis score or the proportion of patients who achieved complete resolution. The majority of trials in PsA did not require patients to have enthesitis at study entry since enthesitis was evaluated only as a secondary outcome. Despite the inherent limitations of the clinical assessment of enthesitis, imaging of the entheses using ultrasound or magnetic resonance imaging has rarely been used in clinical trials to assess response to treatment of enthesitis. This systematic review summarizes existing evidence regarding pharmaceutical and nonpharmaceutical interventions for enthesitis in patients with PsA to facilitate an evidence-based update of the Group for Research and Assessment in Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for PsA.
We performed a systematic literature review to identify 41 randomized clinical trials that reported enthesitis treatment response in patients with PsA. For each intervention, the response effect size was summarized and the quality of evidence was graded. Recommendations were then formulated for the various pharmacological and nonpharmacological therapies.
We included 41 randomized clinical trials in our review and graded each intervention.
Several classes of systemic conventional and advanced therapies and local measures were recommended for active enthesitis in patients with PsA.
附着点炎是儿童和成人银屑病关节炎（PsA）的关键病理和临床特征。附着点炎通常通过临床试验中使用的几种经过验证的附着点炎评分系统进行临床评估。附着点炎的治疗反应报告为附着点炎总评分的变化或达到完全缓解的患者比例。PsA的大多数试验在研究入组时并不要求患者患有附着点炎，因为附着点炎仅作为次要结局进行评估。尽管附着点炎的临床评估存在固有局限性，但在临床试验中很少使用超声或磁共振成像对附着点进行成像来评估附着点炎的治疗反应。本系统评价总结了关于PsA患者附着点炎的药物和非药物干预的现有证据，以促进银屑病和银屑病关节炎研究与评估小组（GRAPPA）对PsA治疗建议的循证更新。
我们进行了一项系统的文献综述，以确定41项报告了PsA患者附着点炎治疗反应的随机临床试验。对于每种干预措施，总结了反应效应大小并对证据质量进行了分级。然后针对各种药物和非药物疗法制定了建议。
我们在综述中纳入了41项随机临床试验，并对每种干预措施进行了分级。
对于PsA患者的活动性附着点炎，推荐了几类全身常规和先进疗法以及局部措施。
