中轴脊柱关节炎诊疗进展概述.ppt

* 研究目的：对nr-axSpA和AS患者2年内的疾病进程进行比较 研究方法：德国脊柱炎起始队列(GESPIC)研究，共纳入早期axSpA患者210例，其中AS 115例（病程≤10年）， nr-axSpA 95例（病程≤5年） 。分别在基线和此后每6个月进行治疗记录和临床评价：疾病活动度（BASDAI、CRP）、功能（BASFI）和脊柱活动（BASMI-3）;基线后每6个月进行ASDAS-CRP和ASAS NSAID 服用评分评价。 研究结果： nr-axSpA和AS患者的BASDAI和BASFI无差异； AS患者CRP较nr-axSpA者更高，但ASDAS- CRP仅在6个月时较高 nr-axSpA的脊柱活动度较AS患者更好，但其差异仅在第6个月和第 12个月时具有统计学显著性 nr-axSpA和AS患者NSAID治疗无差异（NSAIDs评分：33.7±28.0 vs 34.2±28.4，P=0.9） BASMI：AS更高，但只在第6和12个月时差异有统计学显著性 研究结论： nr-axSpA和AS在2年内的疾病进程类似。AS患者的高CRP水平和较差的脊柱活动度提示全身性炎症活动高和更严重的结构破坏。 17例AS和5例nraxSpA在2年随访期内接受至少一次的TNFi治疗，分析时被剔除。 * WPAI：work productivity and activity impairment survey * 1.图A (n=122) 显示： PCS 得分随ASDAS的升高而显著下降，PCS 得分和BASDAI (19.6 vs. 36.1, P0.001) 及BASFI 得分 (32.7 vs. 12.6, P0.001)相关程度相似。 MCS则不受疾病活动度和身体功能的影响。 2. 图B (n=100) 显示： 缺勤率(P=0.02)、带病出勤率(P0.001)和WPL (P0.001) 随ASDAS的增加而增加。 * aAdjusted for age, sex, race, education, disease duration, comorbidities, drug therapy, and country. Most patients (n=376; 67.7%) were employed. Of the employed patients, 54.8% (n=206) had low BASDAI(4), 25.0% (n=94) moderate(4≤,6), and 20.2% (n=76) high(6). Of not employed (n=177), 34.5% (n=61) had a low BASDAI score, 29.4% (n=52) moderate, and 36.2% (n=64) high. The adjusted odds of not being employed were 2.56 times greater in patients with high BASDAI than those with low BASDAI. When compared to patients with low BASDAI, the odds of absenteeism (WPAI) were 2.66 times greater in participants with high BASDAI; presenteeism (WPAI) was 2.90 and 6.96 times more likely for participants with moderate and high BASDAI, respectively * A total of 8,572 AS patients and 39,639 matched general population comparators were included in the study contributing 49,258 person-years (py) respectively 223,985 py. Mean age at study entry was 46 years (inter quartile range 36-56 years) and 65% were male. The univariate HR of NL in AS patients compared to general population comparators was 2.44 (95%CI 2.09 to 2.84). Predictors of NL within the AS group included anti-TNF