强直性脊柱炎骶髂关节炎影像学进展 10 年：DESIR 队列研究。

Sacroiliac radiographic progression over 10 years in axSpA: data from the DESIR inception cohort.

机构信息

Rheumatology, Hospital Cochin Assistance Publique Hôpitaux de Paris, Paris, France

INSERM U1153, Center for Research in Epidemiology and Statistics, Université Paris Cité, Paris, France.

出版信息

Ann Rheum Dis. 2024 Jun 12;83(7):858-864. doi: 10.1136/ard-2023-225184.

DOI:10.1136/ard-2023-225184

PMID:38423758

Abstract

OBJECTIVES

To evaluate sacroiliac radiographic progression over a 10-year follow-up and determine the baseline factors associated with such progression in patients with recent-onset axial spondyloarthritis (axSpA, <3 years).

METHODS

This analysis was performed in the DESIR cohort (NCT01648907). The radiographic status of the patients (radiographic axSpA (r-axSpA) vs non-radiographic axSpA (nr-axSpA)) was based on the modified New York (mNY) criteria. Information on mNY criteria on the pelvic radiographs was obtained in four reading waves over a 10-year period. Images were blinded and centrally read by 3 trained readers. The % of mNY net progressors (ie, number of 'progressors' minus number of 'regressors' divided by the total number of patients) was assessed in completers (ie, pelvic radiographs at baseline and 10 years). The yearly likelihood of mNY+ was estimated using an integrated analysis (ie, including all patients with at least one available mNY score ('intention-to-follow' population) using a generalised estimating equations model and time-varying tumour necrosis factor (TNF) use as a confounder. Baseline predictors of mNY+ during 10 years were evaluated.

RESULTS

Completers included 294 patients, while intention-to-follow included 659 participants. In the completers, the net % progression (from nr-axSpA to r-axSpA) was 5.8%. In the intention-to-follow population, the probability of being mNY+ was estimated to increase 0.87% (95% CI 0.56 to 1.19) per year (ie, 8.7% after 10 years) while when introducing TNF inhibitors (TNFi) as a time-varying covariate, the probability was 0.45% (95% CI 0.09 to 0.81) (ie, 4.5% after 10 years). Baseline bone marrow oedema (BME) on MRI of the sacroiliac joints (SIJ) was associated with being mNY+ over time OR 6.2 (95% CI 5.3 to 7.2) and OR 3.1 (95% CI 2.4 to 3.9) in HLA-B27+ and HLA-B27-, respectively). Male sex, symptom duration >1.5 years, Axial Spondyloarthritis Disease Activity Score ≥2.1 and smoking (only in HLA-B27 positives) were also associated with being mNY+ over 10 years. BME was not found to be a mediator of the HLA-B27 effect on mNY+ at 10 years.

CONCLUSIONS

The yearly likelihood of switching from nr-axSpA to r-axSpA in patients after 10 years of follow-up was low, and even lower when considering TNFi use.

摘要

目的

评估发病后 10 年的骶髂关节影像学进展，并确定近期发病的中轴型脊柱关节炎（axSpA，<3 年）患者中与影像学进展相关的基线因素。

方法

该分析在 DESIR 队列（NCT01648907）中进行。患者的放射学状态（放射学中轴型脊柱关节炎（r-axSpA）与非放射学中轴型脊柱关节炎（nr-axSpA））基于改良纽约（mNY）标准。在 10 年期间的 4 次阅读波中获得了骨盆 X 光片上的 mNY 标准信息。图像是盲法的，并由 3 名经过培训的读者进行中心阅读。在完成者（即基线和 10 年时均有骨盆 X 光片）中评估 mNY 净进展者（即，“进展者”的数量减去“缓解者”的数量除以总患者数）的百分比。使用广义估计方程模型和时间变化的肿瘤坏死因子（TNF）使用作为混杂因素，使用综合分析（即，包括至少有一个可用的 mNY 评分的所有患者（“意向随访”人群））来估计 mNY+的每年可能性。评估了 10 年内 mNY+的基线预测因素。

结果

完成者包括 294 名患者，而意向随访者包括 659 名参与者。在完成者中，净进展百分比（从 nr-axSpA 到 r-axSpA）为 5.8%。在意向随访人群中，mNY+的概率估计每年增加 0.87%（95%CI 0.56 至 1.19）（即 10 年后为 8.7%），而当引入 TNF 抑制剂（TNFi）作为时变协变量时，概率为 0.45%（95%CI 0.09 至 0.81）（即 10 年后为 4.5%）。骶髂关节（SIJ）磁共振成像（MRI）上的骨髓水肿（BME）与 mNY+随时间相关，OR 为 6.2（95%CI 5.3 至 7.2）和 OR 为 3.1（95%CI 2.4 至 3.9），分别为 HLA-B27+和 HLA-B27-。男性、症状持续时间>1.5 年、Axial Spondyloarthritis Disease Activity Score≥2.1 和吸烟（仅在 HLA-B27 阳性者中）也与 mNY+在 10 年内相关。未发现 BME 是 HLA-B27 对 mNY+影响的中介物在 10 年内。