附着点炎在脊柱关节炎患者中的表现及其对生物制剂治疗的反应

Performance of enthesitis in patients with spondyloarthritis and its response to treatment with biological agents

目的分析附着点炎在脊柱关节炎(SpA)患者中的发生情况及其对生物制剂治疗的反应。方法收集560例SpA患者[强直性脊柱炎(AS)组446例、放射学阴性中轴型SpA(nr-axSpaA)组79例和外周型SpA(pSpA)组35例]的临床资料;根据有无附着点炎将其分为无附着点炎组(290例)与附着点炎组(270例);将有至少6个月的完整随访资料的194例患者根据治疗方式不同分为非生物制剂组(32例)及生物制剂组(162例),分别对其临床资料进行分组比较。结果最常发生附着点炎的5个部位是第5腰椎棘突、右髂后上嵴、左髂后上嵴、左跟腱和右跟腱。附着点炎组患者临床医师整体评分(PGA)、红细胞沉降率(ESR)、C反应蛋白(CRP)水平、Bath AS活动性评分(BASDAI)、基于CRP计算的AS活动性评分(ASDAScrp)及外周关节炎患者比例均高于无附着点炎组;胸廓扩张度、腰椎活动度、Bath AS功能指数(BASFI)及关节功能Ⅰ~Ⅱ级患者比例均低于无附着点炎组(P<0.05)。与同组治疗前比较,非生物制剂组患者治疗后马斯特里赫特强直性脊柱炎附着点炎评分(MASES)及附着点炎患者比例均更低;生物制剂组治疗后胸廓扩张度更高,PGA、CRP、ESR、ASDAScrp、BASDAI、BASFI、MASES、附着点炎、外周关节炎、加拿大脊柱关节炎研究学会(SPACC)评分>0分患者比例均更低;与非生物制剂组同期比较,生物制剂组患者治疗前胸廓扩张度均更低,治疗后CRP、ASDAScrp均更低(P<0.05)。多因素logistic回归分析结果显示,ASDAScrp升高、合并外周关节炎为SpA患者发生附着点炎的危险因素,ESR升高、使用生物制剂为其保护因素(P<0.05)。结论SpA患者合并附着点炎提示疾病活动。ASDAScrp和合并外周关节炎为SpA发生附着点炎的危险因素,而使用生物制剂可以减少附着点炎的发生。

Objective To analyzed the prevalence of enthesitis in patients with spondyloarthritis(SpA)and its response to treatment with biological agents.Methods Clinical data of 560 SpA patients[446 patients in ankylosing spondylitis(AS)group,79 patients in non-radiographic axial spondyloarthritis(nr-axSpaA)group and 35 patients in peripheral spondyloarthritis(pSpA)group]were collected.According to the presence and absence of enthesitis,they were dived into non-enthesitis group(290 cases)and enthesitis group(270cases).194 patients with complete follow-up data for at least 6 months were divided into non-biological agents group(32 cases)and biological agents group(162 cases)according to different treatment methods.Their clinical data were compared respectively.Results The five most common sites of enthesitis were spinous processes of the fifth lumbar spine,right posterior superior iliac crest,left posterior superior iliac crest,left achilles tendon and right achilles tendon.Physician’s Global Assessment(PGA),the levels of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)level,Bath AS Activity Score(BASDAI),CRP-based AS activity score(ASDAScrp)and the proportion of peripheral arthritis patients in enthesitis group were higher than those in non-enthesitis group;the thoracic expansion,lumbar range of motion,BASFI and the proportion of patients with gradeⅠ-Ⅱjoint function in enthesitis group were lower than those in non-enthesitis group(P<0.05).Compared with the same group before treatment,MASES and the proportion of patients with enthesitis were lower in non-biological agents group after treatment.The degree of chest expansion was higher in biological agents group after treatment and PGA,CRP,ESR,ASDAScrp,BASDAI,Bath AS Functional Index(BASFI),Maastricht ankylost spondylitis Adhesion Score(MASES),the proportions of patients with enthesitis,peripheral arthritis and Spondyloarthritis research consortium Canada(SPARCC)score>0 point were lower;compared with non-biological agents group,degree of chest expansion in biological agents group was lower during the same period before treatment,CRP and ASDAScrp were lower after treatment(P<0.05).The multivariate logistic regression analysis showed that elevated ASDAScrp and peripheral arthritis were the risk factors for enthesitis in SpA patients,increased ESR and use of biological agents was the protective factor for enthesitis in SpA patients(P<0.05).Conclusion Combined enthesitis in SpA patients suggests disease activity,ASDAScrp and combined peripheral arthritis are risk factors for enthesitis in SpA and use of biological agents can reduce the occurrence of enthesitis.