脊柱关节病的目标治疗与目标治疗——刘毅主任.pptVIP

J Braun，et al. ARD 2006,65:1147-1153 关于DMARDs治疗AS 传统DMARDs治疗AS疗效不佳 [1] Braun J. et al. Ann Rheum Dis 2006,Apr 10 1147-53 [2] Habel et al. Ann Rheum Dis 2005, 64;296-8 [3] Habel et al. A & R 2006, 54;678-81 INF联合MTX未能提供有效意义 关于TNF抑制剂治疗AS TNF?诱导的炎症在AS发病中起重要作用 Changes between the first and second update of the recommendations for the use of anti-TNF agents in patients with ankylosing spondylitis 2006 update recommendations Diagnosis Patients normally fulfilling modified New York criteria for definitive ankylosing spondylitis Active disease Active disease for >4 weeks BASDAI>4 and positive expert opinion Treatment failure All patients: should have had adequate therapeutic trials of at least two NSAIDs;defines as for at least 3 months at maximum recmmended dose unless contradicated;<3 months in cases of intolerance,toxicity Axial disease: no pretreatment with DMARDs required Peripheral arthritis: one local corticosteroid injiectin if appropriate; therapeutic trial of sulfasalazine (4 months maximum tolerated dose) mandatory Enthesitis: appropriate local treatment Contraindications: List of contraindications Assessment of disease: ASAS core set for daily practice and BASDAI Assessment of response: 50% improvement in BASDAI or absolute change of 2 and positive expert opinion in favour of continuation Assessment between 6 and 12 weeks 2010 update recommendations Diagnosis Patients normally fulfilling modified …. for definitive ankylosing spondylitis or the ASAS criteria for axial SpA Active disease Active disease for >4 weeks BASDAI>4 and positive expert opinion Treatment failure All patients: should have had adequate therapeutic trials of at least two NSAIDs; defined as at least two NSAIDs over a 4- week period in total at maximum recommended dose unless contraindicated; Axial disease: no pretreatment with DMARDs required Peripheral arthriti