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  • 宋旻恺△,肖军△,江伟州,严涛,高嘉文,史占军*.依那西普和传统合成改善病情抗风湿药物序贯治疗对髋关节受累强直性脊柱炎患者的疗效评估[J].第二军医大学学报,2020,41(6):668-672    [点击复制]
  • SONG Min-kai△,XIAO Jun△,JIANG Wei-zhou,YAN Tao,GAO Jia-wen,SHI Zhan-jun*.Sequential therapy with etanercept and conventional synthesis disease-modifying anti-rheumatic drugs in treating ankylosing spondylitis patients with hip involvement: an evaluation of therapeutic effect[J].Acad J Sec Mil Med Univ,2020,41(6):668-672   [点击复制]
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依那西普和传统合成改善病情抗风湿药物序贯治疗对髋关节受累强直性脊柱炎患者的疗效评估
宋旻恺△,肖军△,江伟州,严涛,高嘉文,史占军*
0
(南方医科大学南方医院关节与骨病外科, 广州 510000
共同第一作者
*通信作者)
摘要:
目的 评估肿瘤坏死因子抑制剂(TNFi)和传统合成改善病情抗风湿药物(csDMARD)序贯治疗方案在延缓强直性脊柱炎(AS)患者受累髋关节影像学进展及维持功能方面的疗效。方法 选择存在髋关节疼痛、活动受限的活动期AS患者,定期检测炎症反应指标CRP、红细胞沉降率(ESR)并使用基于CRP的强直性脊柱炎疾病活动度评分(ASDASCRP)评估其疾病活动度,根据疾病活动度序贯使用TNFi依那西普与csDMARD方案。分别于治疗前和治疗后3、6、12个月,使用基于视觉模拟量表的患者整体评价评估受试者主观症状, ASDASCRP、巴氏强直性脊柱炎疾病活动度指数(BASDAI)评估病情,巴氏强直性脊柱炎功能指数(BASFI)评估躯体功能,巴氏强直性脊柱炎髋关节影像学指数(BASRI-hip)及最小关节间隙宽度(mJSW)评估髋关节影像学改变。结果 共纳入受试者51例,男38例(74.5%),女13例(25.5%),年龄为10~56岁,发病年龄为9~40岁,均未因髋关节功能受限或关节骨质进一步破坏行髋关节置换术。治疗后3、6、12个月, 51例AS患者的国际强直性脊柱炎评价(ASAS)工作组20%缓解标准(ASAS20)缓解率分别为70.59%(36/51)、84.31%(43/51)和96.08%(49/51),ASAS工作组40%缓解标准(ASAS40)缓解率分别为58.82%(30/51)、78.43%(40/51)和86.27%(44/51)。治疗后3、6、12个月,炎症反应指标CRP水平、ESR及患者整体评价评分、ASDASCRP、BASDAI评分、BASFI评分均呈下降趋势(P均<0.05), BASRI评分和mJSW总体趋势无明显变化(P均>0.05)。结论 TNFi和csDMARD序贯治疗方案可以有效抑制AS患者的炎症,阻止髋关节破坏进展,改善髋关节功能,保持髋关节间隙稳定。
关键词:  强直性脊柱炎|依那西普|抗风湿药|髋关节
DOI:10.16781/j.0258-879x.2020.06.0668
投稿时间:2019-12-15修订日期:2020-02-05
基金项目:广东省教育厅高水平大学建设经费南方医科大学临床研究启动项目(LC2019ZD022).
Sequential therapy with etanercept and conventional synthesis disease-modifying anti-rheumatic drugs in treating ankylosing spondylitis patients with hip involvement: an evaluation of therapeutic effect
SONG Min-kai△,XIAO Jun△,JIANG Wei-zhou,YAN Tao,GAO Jia-wen,SHI Zhan-jun*
(Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou 510000, Guangdong, China
Co-first authors.
* Corresponding author)
Abstract:
Objective To evaluate the efficacy of sequential therapy with tumor necrosis factor inhibitor (TNFi) and conventional synthesis disease-modifying anti-rheumatic drugs (csDMARDs) in delaying imaging progress and maintaining function of the affected hip in ankylosing spondylitis (AS) patients. Methods AS patients with hip pain and limited activity were enrolled in this study. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured regularly, and ankylosing spondylitis disease activity score based on C-reactive protein (ASDASCRP) was performed to evaluate the disease activity. Etanercept (a TNFi) and csDMARDs were used sequentially according to the disease activity. Before sequential therapy and 3, 6 and 12 months after sequential therapy, the subjective symptoms were assessed by visual analogue scale, the condition was assessed using ASDASCRP and Bath ankylosing spondylitis disease activity index (BASDAI), the body function was assessed using Bath ankylosing spondylitis function index (BASFI), and the imaging changes of hip joint lesions were assessed using Bath ankylosing spondylitis radiology index-hip (BASRI-hip) and minimum joint space width (mJSW). Results A total of 51 patients (38 males[74.5%] and 13 females[25.5%]) aged from 10-56 years were enrolled, and the onset age was 9-40 years. No hip arthroplasty was performed due to limited hip function or further damage of hip joint structure. Based on assessments in ankylosing spondylitis (ASAS) Work Group criteria, 70.59% (36/51), 84.31% (43/51) and 96.08% (49/51) patients met the ASAS20 criteria and 58.82% (30/51), 78.43% (40/51) and 86.27% (44/51) patients met the ASAS40 criteria 3, 6 and 12 months after sequential therapy, respectively. At the follow-up points of 3, 6 and 12 months, the overall trends of CRP level and ESR, patient global assessment score, ASDASCRP, BASDAI score and BASFI score were significantly decreased (all P<0.05), while the overall trends of BASRI score and mJSW were not significantly changed (both P>0.05). Conclusion Sequential therapy with etanercept (a TNFi) and csDMARDs can effectively inhibit inflammation, avoid further damage of hip joint, improve joint function, and keep the hip joint space width in AS patients.
Key words:  ankylosing spondylitis|etanercept|antirheumatic agents|hip jiont