TNF-α阻断治疗强直性脊柱炎髋关节

受累率高，炎性病变超声表现减少

研究高疾病活动度强直性脊柱炎患者临床，超声和放射学髋关节受累的患病率，并探讨之间的关联。研究还分析了为时6个月的TNF-α阻断治疗对髋关节的压痛和炎症能量多普勒超声的影响。

针对接受TNF-α阻断治疗的强直性脊柱炎的连续患者髋关节受累进行研究。分析基线期患者报告的髋关节受累,并进行影像学评估(BASRI-髋关节)。治疗前和6个月后进行临床检验(髋关节压痛)和超声检测。

例患者中,20%报告有髋受累病史。23%的患者在基线期出现了髋关节压痛。超声结果显示,17%的患者有炎性病变,其中74%得到能量多普勒结果证实。20%的患者出现结构病变,其中55%有骨质疏松症。10%的患者影像学显示结构损伤。髋受累病史与放射学髋关节受累之间的一致性最高(PHI系数0.)。经过6个月的TNF-α阻断治疗,髋关节压痛(29到11)、炎症超声病变总数（29到9)和功能多普勒正交信号(22到6)明显下降。

根据针对髋关节的研究，强直性脊柱炎患者髋关节受累的患病率为10％到23％不等。TNF-α阻断疗法显著改善了髋关节压痛，以及能量多普勒显示的炎性超声病变。

Highprevalenceofhipinvolvementanddecreaseininflammatoryultrasoundlesionsduringtumournecrosisfactor-αblockingtherapyinankylosingspondylitis

Objectives:

Toassesstheprevalenceofclinical,USandradiographichipinvolvementinASpatientswithactivediseaseandtoexploretheassociationsbetweentheseassessments.Furthermore,toevaluatetheeffectof6monthsofTNF-αblockingtherapyontenderandinflammatorypowerDopplerUSlesionsofhipjoints.

Methods:

ConsecutiveASpatientsstartingTNF-αblockingtherapywereevaluatedforhipjointinvolvement.Atbaseline,patient-reportedhistoryofhipinvolvementwasassessedandradiographicevaluation(BASRI-hip)wasperformed.Clinicalexamination(tenderhipjoints)andUSexaminationtookplacebeforeandafter6monthsoftreatment.

Results:

Oftheincludedpatients,20%reportedahistoryofhipinvolvement.Atbaseline,tenderhipjointswerepresentin23%ofpatients.USexaminationshowedinflammatorylesionsin17%ofpatients,ofwhich74%hadpositivepowerDoppler.Structurallesionswerepresentin20%ofpatients,ofwhich55%hadosteophytes.Structuralradiographicdamagewasseenin10%ofpatients.Highestconcordancewasfoundbetweenhistoryofhipinvolvementandradiographichipinvolvement(phicoefficient0.).After6monthsofTNF-αblockingtherapy,significantdecreasewasfoundintenderhipjoints(from29to11),totalnumberofinflammatoryUSlesions(from29to9)andpositivepowerDoppler(from22to6).

Conclusion:

TheprevalencerateofhipinvolvementinASpatientsvariesfrom10to23%,dependingonthetypeofhipassessment.TNF-αblockingtherapysignificantlyimprovedtenderhipjoints,andinflammatoryUSlesionsincludingpositivepowerDoppler.

文章出处:

FrekeWink,SuzanneArends,FionaMaas,etal.Rheumatology.Published:08January

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