比较病程长和短的中轴脊柱关节炎患者接受1年依那西普治疗的临床和炎症预后

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Differences in Clinical and Inflammation Outcomes in Patients with Axial Spondyloarthritis of Shorter and Longer Disease Duration After One Year Treatment with Etanercept

 

 

Anja Weiß ¹, In-Ho Song², Kay-Geert Hermann³, Christian Althoff³, Bruce Freundlich⁴, Martin Rudwaleit⁵, Joachim Listing¹ and Joachim Sieper⁶, ¹German Rheumatism Research Centre, Berlin, Germany, ²Charité Medical University, Campus Benjamin Franklin, Berlin, Germany, ³Charite Medical School, Berlin, Germany, ⁴University of Pennsylvania, Philadelphia, PA, ⁵Ev. Krankenhaus Hagen-Haspe, Hagen, Germany, ⁶Charité – Campus Benjamin Franklin, Berlin, Germany

 

Presentation Number: 1329

 

Background/Purpose: To investigate the influence of the disease duration on the outcome in patients with axial spondylarthritis (SPA)

Methods: 62 patients with axial SpA with a symptom duration of less than 5 years were treated with Etanercept (ETA) for one year, either with ETA until week 48 (n=40) or they were switched from sulfasalazine treatment in the first year to ETA in the second year from week 48 until week 108 (n=26), as part of the ESTHER trial (1). 52% of these patients had a diagnosis of radiographic axial SpA and 48% had radiographic sacroiliitis. The patients were stratified into two groups: less than 3 years and more than 3 years of symptom duration before inclusion into the trial. These two groups were compared for clinical, CRP and magnetic resonance imaging (MRI)-outcome parameters using analysis of covariance (ANCOVA) with baseline status as covariable. Spearman correlation coefficients are calculated to analyse the relationship between two variables. 

Results: Clinical parameters such as Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis metrology index (BASMI) showed significantly better improvement for short vs longer diseased patients (Table 1). The results for improvement of MRI inflammation score for sacroiliac joints (SIJ) and spine and for CRP showed no significant differences between the two groups (Table 1). In patients with SIJ score at baseline > 0 the change in BASDAI showed a correlation with the change in SIJ score in patients with a short disease duration (rho=0.4, p=0.05) and longer disease duration (rho=0.4, p=0.06). The correlation between spine score and BASDAI was weaker. Significant correlation between BASDAI and CRP was found for short diseased patients (rho=0.6, p=0.002) but not for longer diseased patients (rho=0.3, p=0.14). Interestingly, patients fulfilling the New York criteria for radiographic sacroiliitis did not differ from patients not fulfilling the criteria regarding change in BASDAI (p=0.97), BASFI (p=0.7), BASMI (p=0.21), CRP (p=0.93), MRI spine score (p=0.74) and MRI SIJ score (p=0.66).

Conclusion: In patients with early axial SpA treated with ETA for one year short diseased patients showed a better improvement in all clinical parameters such as BASDAI, BASFI and BASMI than longer diseased patients, but such a difference was not present for objective parameters of inflammation such as MRI inflammation and CRP. These data indicate that patients with longer symptom duration respond less well to TNF-blockade for reasons which go beyond structural damage.

 

[1] Song I.-H. et al.  2011. Ann Rheum Dis. 2011 Apr;70(4):590-6.

 

比较病程长和短的中轴脊柱关节炎患者接受1年依那西普治疗的临床和炎症预后

Anja Weiß, , et al. ACR 2011. Present No:1329

背景/目的:探讨病程对中轴脊柱关节炎 (SPA) 患者预后的影响。

方法:作为ESTHER研究一部分，62例病程少于5年的SpA患者应用依那西普(ETA)治疗1年,ETA应用直到48周(n = 40)或者柳氮磺氨吡碇应用1年后从48周到108周转为ETA治疗(n=26) (1)。52%的病人诊断影像学的SpA,48%有影像学骶髂关节炎。 患者分为两组:入组研究前病程少于3年或超过3年。应用析因分析法(ANCOVA)将基线水平作为变量，比较两组临床、CRP和核磁共振成像(MRI)等疗效指标。Spearman相关系数分析计算两两变量的相关性。

结果:临床参数如Bath强直性脊柱炎疾病活动指数(BASDAI)、Bath强直性脊柱炎功能指数(BASFI)和Bath强直性脊柱炎计量指数(BASMI)都显示病程短的患者改善明显优于病程长的患者 (表1)。骶髂关节(SIJ)和脊柱的MRI炎症评分和CRP水平在两组间无明显差异 (见表1)。基线SIJ评分> 0的患者中， SIJ变化与短病程的BASDAI变化 (rho= 0.4,p = 0.05)相关，长病程的则不明显(rho= 0.4,p = 0.06)。脊柱积分与BASDAI的相关性较弱。病程短的患者中BASDAI与CRP之间显著相关 (rho= 0.6,p = 0.002),但病程长的患者中无此相关性(rho= 0.3,p = 0.14)。有趣的是,是否符合纽约放射学骶髂关节炎标准的患者在BASDAI (p = 0.97)、BASFI(p = 0.7)、BASMI(p =0.21), CRP(p = 0.93),脊柱MRI评分(p = 0.74)和核磁共振SIJ评分(p = 0.66)的改变上没有差异。

结论:接受依那西普治疗1年的早期中轴SpA患者，病程短的改善更明显，其表现在所有临床参数,如BASDAI,BASFI BASMI,但这种差异并没有出现在客观的炎症评价指标上，如MRI和CRP。这些数据表明,病程长的患者由于已经有机构破坏，对TNF阻滞剂反应相对较差 。

Table 1: Mean outcome parameters at baseline, adjusted means under treatment with etanercept and adjusted mean changes from baseline.  Adjustment was made for baseline status (95% confidence intervals (CI) were given).

 

Parameter	Means at baseline		Adjusted means under ETA therapy		Adjusted mean changes (95% CI)		p-value
	< 3years n=32	>= 3 years n=34	< 3years n=32	>= 3 years n=34	< 3years n=32	>= 3 years n=34
BASDAI	5.0	5.4	2.5	3.4	2.7 (2.1, 3.3)	1.8 (1.2, 2.3)	0.028
BASFI	3.9	4.2	1.8	2.9	2.2 (1.7, 2.8)	1.2 (0.7, 1.7)	0.004
BASMI	1.9	2.1	1.4	1.9	0.6 (0.3, 0.9)	0.1 (-0.2, 0.4)	0.012
CRP	10.8	8.1	5.5	4.7	4.4 (1.6, 7.1)	5.3 (2.5, 7.8)	0.690
MRI spine score	1.3	2.2	0.99	0.7	0.9 (0.3, 1.4)	1.2 (0.6, 1.7)	0.470
MRI SIJ score	5.9	6.0	1.5	2.3	4.4 (3.7, 5.1)	3.6 (2.9, 4.3)	0.090