脊柱关节炎诊断及治疗进展-培训课件.pptVIP

新指南提升关节外表现的诊疗价值，并明确对单抗类和融合蛋白类TNFi做出区分 Ward MM et al. Presented at ACR 2014. 治疗方案的选择 早诊断、早治疗 联合治疗 个体化 随诊调整方案 谢谢大家 * * * * * * * * * AS的治疗是否有效，是否可以达标？需要定期监测疾病活动度指标，那么评估AS疾病活动度指标有哪些呢？ BASDAI ：即Bath强直性脊柱炎疾病活动指数：包括疲乏、中轴及外周关节疼痛、晨僵和肌腱端痛，共有6个问题组成，让患者回答过去1周的症状。前5个问题用10cm VAS法完成，最高得10分，最后1个问题根据晨僵时间长短而得分。 ≥4提示疾病活动。 C反应蛋白为炎性反应指标之一，正常值不超过10mg/L，升高表示炎性反应活跃。 另外，核磁也是评估活动性炎症损伤的指标。 2010年ASAS指南推荐AS缓解评估指标： 缓解标准：BASDAI 50%改善或绝对值改善2分(0-10分)及专家建议； 评估时间：至少12周。 参考文献 Désirée van der Heijde , et al. Ann Rheum Dis 2011;70:905–908 汪年松.强直性脊柱炎.人民卫生出版社.2009:89-90 I-H Song, et al. Ann Rheum Dis 2011;70:590–596 * * * * * Objective. To evaluate the efficacy and safety of celecoxib in patients with ankylosing spondylitis (AS). Methods. This was a 12-week randomized, double-blind, placebo-controlled study with 4 treatment arms: celecoxib 200 mg qd, celecoxib 400 mg qd, naproxen 500 mg bid, and placebo. Patients (age 18–75 yrs) requiring daily treatment with nonselective nonsteroidal antiinflammatory drugs, and with a pain intensity on visual analog scale (VAS) 3 50 mm worsening by 30% compared with a preinclusion visit (14 days prior) were studied. Primary endpoints were least-squares mean changes from baseline in pain intensity, disease activity (patient global assessment VAS), and functional impairment [Bath Ankylosing Spondylitis Functional Index (BASFI)]. Adverse events were monitored throughout the study. Results. Of 611 randomized patients, 137 were allocated to celecoxib 200 mg, 161 to celecoxib 400 mg, 157 to naproxen, and 156 to placebo. Improvements in least-squares mean pain intensity, disease activity, and BASFI scores were significantly greater in the celecoxib 200 mg, celecoxib 400 mg, and naproxen groups than in the placebo group (p 2 0.001) at Week 12 and the interim timepoints, Weeks 1, 3, and 6. Celecoxib 400 mg was as effective as naproxen; however, naproxen was more effective than celecoxib 200 mg. Celecoxib was well tolerated, with an adverse event profile similar to placebo.