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[2272] - A Prospective Inception Cohort Study of the Clinical Presentation and Response to Treatment of Undifferentiated Spondyloarthritis Versus Ankylosing Spondylitis and Psoriatic Arthritis. | 前瞻性起始队列研究比较未分化脊柱关节炎、强直性脊柱炎和银屑病关节炎患者的临床表现与治疗反应
Paramarta JE, et al. ACR 2010. Present No: 2272.
背景: 强直性脊柱炎(AS)与银屑病关节炎(PsA)是研究最多的脊柱关节炎(SpA)亚型。相当一部分SpA患者并不符合AS和PsA的分类标准,有可能延误诊断及治疗。本研究旨在探讨未分化SpA(USpA)与AS、PsA在患者特征、疾病活动度及治疗反应是否存在差别。 方法: 175例就诊于SpA专科门诊、符合ESSG标准的患者被纳入前瞻性起始队列。每3个月进行疾病活动度评估,包括患者和医生VAS、Bath强直性脊柱炎疾病活动度评分(BASDAI)、68个肿胀和压痛关节计数、Schober、ESR和CRP。正态分布资料采用参数检验,非正态分布资料采用非参数检验。 结果: 表1列出了基线期人口学资料和临床资料。 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
表1. 基线期人口学资料与疾病活动度
正态分布: 未配对t检验;非正态分布: Mann-Whitney;分类资料: Chi2 与USpA相比,* 趋势(0.05<p<0.1),** 显著差异(p<0.05 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The cohort included 40 USpA, 74 AS and 45 PsA patients. The age of onset (median 32 years; range 11-62), disease duration (1.3 years; 0-36), and proportion of male patients (42.5%) were lower in USpA than in AS and PsA. USpA patients had more axial and less peripheral disease than PsA, but less axial and more peripheral disease than AS. The presence of HLA-B27 (43%) and either high or low grade sacroiliitis (47.5%) were less frequent in USpA than in AS. Only 25% of the USpA patients fulfilled the ASAS criteria for pre-radiological AS, although it should be noted that MRI was not systematically performed. Half of the USpA group had a positive family history. Despite the atypical presentation, the baseline disease activity (VAS patient/physician and BASDAI) was higher in USpA than in the other groups. Upon initiation of TNF blockade in patients with high disease activity, we observed a significant and sustained decrease of the disease activity in USpA, which was similar in amplitude to the response in AS and PsA (Figure 1). | 共纳入40例USpA、74例AS和45例PsA患者。USpA患者的起病年龄(中位数年龄为32岁,范围: 11~62岁)、病程(1.3年,0~36年)和男性患者比例(42.5%)均低于AS和PsA患者。与PsA患者相比,USpA患者中轴病变更多,周围病变更少;与AS相比,USpA患者中轴病变更少,周围病变更多,而且HLA-B27阳性率(43%)、轻度或重度骶髂关节炎发生率(47.5%)更低。仅有25% USpA患者符合ASAS放射学前期AS的标准,但并未系统进行MRI检查。半数USpA患者有阳性家族史。尽管症状不典型,但USpA的基线期疾病活动度(患者/医生VAS和BASDAI)高于其他两组。疾病活动度高且使用了TNF抑制剂的USpA患者疾病活动度显著并持续下降,这与AS和PsA的反应相似(表1)。 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Conclusion: USpA displays an intermediate phenotype between AS and PsA, with only part of the patients representing pre-radiological axial SpA. Despite the atypical presentation and shorter disease duration, a large majority of USpA patients have high disease activity. The apparent efficacy of TNF blockers in this observational study, together with the emerging data of RCT in pre-radiological AS pleas for systematic assessment of novel treatments not only in AS and PsA but also in axial and peripheral USpA. | 结论: USpA是介于AS与PsA之间的表型,仅有部分患者表现为放射学前期中轴型SpA。虽然表现不典型、病程较短,但大部分USpA患者病情活动度高。本研究发现TNF抑制剂疗效明显,而且放射学前期AS的随机对照研究数据越来越多,除了AS和PsA之外,我们应系统评估这种新疗法在中轴型和周围型USpA中的作用。 |
USpA
是介于
AS
与
PsA
之间的表型,仅有部分患者表现为放射学前期中轴型
SpA
。虽然表现不典型、病程较短,但大部分
USpA
患者病情活动度高。本研究发现
TNF
抑制剂疗效明显。
放射学前期
AS
的随机对照研究数据越来越多,除了
AS
和
PsA
之外,我们应系统评估这种新疗法在中轴型和周围型
USpA
中的作用。
转载于:https://www.cnblogs.com/T2T4RD/archive/2010/12/15/5464347.html