儘早長期使用TNF-α抑制劑可緩解強直性脊柱炎患者影像學進展
儘早長期使用TNF-α抑制劑
可緩解強直性脊柱炎患者
影像學進展
目 標
評估使用TNF-α抑制劑治療強直性脊柱炎（AS）的影像學進展。
方 法
本研究物件為一家三級醫院1995年至2014年期間接受TNFi治療且至少每2年接受一次影像學病情評估的AS患者。啟用TNFi的時間定義為從症狀發作到開始使用TNFi的時間。TNFi指數定義為TNFi使用期與整個疾病期的比率。透過改良Stroke強直性脊柱炎脊柱評分法（mSASSS）評估影像學損傷。使用單變數和多變數線性迴歸分析來確定影響患者影像學進展的因素。
結 果
共有151名患者被納入分析。17名（11.3％）患者為女性，年平均mSASSS為1.01單位/年。
平均X射線隨訪時間為102.9±54.9個月。
從症狀發作到開始使用TNFi的平均時間為104.8±83.6個月（中位數84個月），平均TNFi指數為42.9±23.8％（中位數為40.9％）。
在多變數分析中，初始mSASSS、初始C反應蛋白、體重指數、現時吸菸者和TNFi的使用延遲與放射學進展相關。外周關節炎和TNFi指數與放射學進展呈負相關。
結 論
TNF-α抑制劑可以延緩AS患者影像學進展，尤其是對於儘早使用和長期維持的患者來說保護效應更佳。
原 文
Effect of tumor necrosis factor α inhibitors on spinal radiographic progression in patients with ankylosing spondylitis
Aim
To evaluate the effect of tumor necrosis factor α inhibitors (TNFi) on spinal radiographic progression in patients with ankylosing spondylitis (AS).
Methods
Subjects were selected from patients at a single tertiary hospital between 1995 and 2014. Patients who used TNFi with baseline and paired follow‐up radiographic data with a minimum interval of 2 years were included. Time to start TNFi was defined as the time from symptom onset to the start of TNFi use. TNFi index was defined as the ratio of the period of TNFi use to the entire period of disease. Radiographic damage was assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Univariable and multivariable linear regression analyses were used to identify factors associated with radiographic progression.
Results
A total of 151 patients were included in the analysis. Seventeen (11.3%) patients were female and mean ΔmSASSS/year was 1.01 units/year. Mean X‐ray follow‐up duration was 102.9 ± 54.9 months. Mean time from symptom onset to start of TNFi use was 104.8 ± 83.6 months (median 84 months) and mean TNFi index was 42.9 ± 23.8% (median 40.9%). In multivariable analysis, initial mSASSS, initial C‐reactive protein, body mass index, current smoker, and delayed start of TNFi use were associated with radiographic progression. Presence of peripheral arthritis and the TNFi index were negatively associated with radiographic progression.
Conclusions
A delay in starting TNFi use and low TNFi index were associated with radiographic progression. Early and long‐term use of TNFi appear to reduce spinal radiographic progression in patients with AS.
文章出處：
Hyemin Jeong, Yeong Hee Eun, In Young Kim, Eun‐Jung Park, Hyungjin Kim, Jaejoon Lee, Chan Hong Jeon, Eun‐Mi Koh, Hoon‐Suk Cha. International Journal of Rheumatic Diseases. 2-Apr-18.
https://onlinelibrary.wiley.com/doi/abs/10.1111/1756-185X.13270
