强直性脊柱炎张斌课件_1.ppt

* * Sacroiliitis：骶髂关节炎 * * * * * The ASsessment in AS (ASAS) working group together with the European League Against Rheumatism (EULAR) have developed evidence-based recommendations for the management of AS. With disease progression moving vertically from top to bottom, this figure emphasises the importance of nonpharmacological treatments throughout the course of the disease, early introduction of NSAIDs and options for refractory disease and alternatives for concomitant peripheral disease including TNF? inhibitors. Reference Zochling J, van der Heijde D, Burgos-Vargas R, et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2006;65:442-452. * 氨羟二磷酸二钠 * * * DMARDs are not effective in axial manifestations of AS. Three open-label studies were conducted to evaluate their efficacy in AS. The first evaluated anakinra (100 mg/day) over 24 weeks in 20 NSAID-refractory patients with AS; only 13 completed the study. One of the primary end points was the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) improvement after 6 months. There was a small and non-significant decrease in the absolute BASDAI over the 6-month study period. In this study, anakinra improved spinal symptoms in only a small subgroup of patients with active AS.1 The second study evaluated the efficacy of leflunomide in patients with active AS. Twenty patients with AS were given leflunomide (20 mg/day) for 6 months. The primary end point was a reduction of disease activity as measured by the BASDAI of 25% at 6 months. The absolute BASDAI did not change significantly over the 6-month study. Only those with peripheral arthritis improved significantly with leflunomide treatment; axial symptoms did not improve.2 Another study also demonstrated the lack of efficacy of leflunomide in AS. In this placebo-controlled study, leflunomide treatment did not result in a significant improvement of the ASAS 20 response in active AS.3 The third study evaluated the therap