强直性脊柱炎达标治疗ppt课件.pptVIP

谢谢大家 Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor alpha blockers in ankylosing spondylitis. Abstract BACKGROUND: TNFalpha blockers have been shown to be highly efficacious in patients with active ankylosing spondylitis (AS). OBJECTIVE: To identify parameters predicting the clinical response to TNF blockers in AS. METHODS: Patients with active AS participated in two placebo controlled, randomised trials conducted in Germany with infliximab (n = 69) and etanercept (n = 30), respectively. For inclusion in either trial patients had to have high disease activity (BASDAI or=4) and a spinal pain score (numerical rating scale 0-10) or=4 despite treatment with NSAIDs. A major clinical response was defined as a 50% improvement of the initial BASDAI (BASDAI 50) after 12 weeks treatment with active drug. Logistic regression likelihood ratio tests (univariate and multivariate), Students t test, and chi(2) tests were performed. RESULTS: Univariate analysis showed the following to be predictors of a major response (BASDAI 50) to treatment: shorter disease duration (p = 0.003); lower BASFI (p = 0.007); younger age (p = 0.009); raised ESR (p = 0.033); raised CRP (p = 0.035). After adjustment for disease duration, BASFI, ESR, and CRP, but not age, remained significantly associated. After adjustment for disease duration and for BASFI, ESR, CRP, and in addition, a higher BASDAI were significantly associated with response. The best multivariate model built by stepwise regression contained the covariables disease duration, BASFI, BASDAI, and CRP. CONCLUSION: A shorter disease duration, younger age, and a lower BASFI are predictors of a major clinical response to TNF blockers in active AS. Raised CRP and a higher BASDAI may also be valuable predictors. These data need to be confirmed in further studies. * 2010年国际脊柱关节炎评估协会针对AS应用TNF抑制剂的推荐如上。对于确诊AS，疾病处于活动期，中轴型患者，在接受2种NSAIDs充分治疗后效果不佳，则可选择TNF抑制剂治疗；以外周关节炎表现为主的患者，除了NSAIDs充分治疗无效，在局部激素治疗和传统DMARDs治疗仍效果不佳时，可选用TNF抑制剂；