银屑病关节炎患者附着点炎的管理：为2021年GRAPPA治疗建议提供信息的最新文献综述

Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations.

作者信息

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

机构信息

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.

出版信息

J Rheumatol. 2023 Feb;50(2):258-264. doi: 10.3899/jrheum.220312. Epub 2022 Nov 1.

DOI:10.3899/jrheum.220312

PMID:36319005

Abstract

OBJECTIVE

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.

METHODS

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.

RESULTS

We included 41 randomized clinical trials in our review and graded each intervention.

CONCLUSION

Several classes of systemic conventional and advanced therapies and local measures were recommended for active enthesitis in patients with PsA.

摘要

目的

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。