How should treatment effect on spinal radiographic progression in patients with ankylosing spondylitis be measured?
How should treatment effect on spinal radiographic progression in patients with ankylosing spondylitis be measured?
复制标题
DOI：
10.1002/art.21133
复制
发表时间：
2005-07-01
影响因子：
--
通讯作者：
van der Linden, S
中科院分区：
文献类型：
--
作者：
van der Heijde, D;Landewé, R;van der Linden, S
强直性脊柱炎（AS）是一种慢性炎症性疾病，其特征是疼痛，僵硬，并经常损害脊柱的活动性。后者是由于脊柱炎症以及糜烂和脊椎韧带赘生物的形成，并可能导致完全强直（“竹脊柱”）。AS的疾病负担与类风湿性关节炎（RA）相当（1-3）。我们小组最近的研究已经令人信服地表明，AS的放射学损伤干扰了长期功能，与实际疾病活动无关[4]，因此，放射学损伤是治疗干预的重要靶点。RA领域的既往经验可能会产生这样的印象，即导致放射学损伤的炎症因果链可能适用于AS，这在RA中已得到证实。然而，目前还缺乏确切的证据表明AS患者的脊柱炎症实际上先于放射学损伤。到目前为止，还不可能在早期阶段预测哪些患者会随着时间的推移而发生脊柱的显著放射学损伤，哪些患者不会。在强直性脊柱炎国际研究（OASIS）的结局中（5）（见下文），唯一具有一定预后能力的变量是
Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by pain, stiffness, and often, impaired mobility of the spine. The latter is due to spinal inflammation as well as the formation of erosions and vertebral syndesmophytes, and may result in complete ankylosis (“bamboo spine”). AS has a burden of illness comparable with that of rheumatoid arthritis (RA)(1–3). Recent research from our group has now convincingly shown that radiographic damage in AS interferes with long-term functioning, independent of actual disease activity (4), and therefore, radiographic damage is an important target for therapeutic intervention.Previous experience in the field of RA may create the impression that the causal chain of inflammation leading to radiographic damage may hold for AS, as has been proven for RA. However, firm evidence that inflammation of the spine in AS actually precedes radiographic damage in a causal manner is currently lacking. To date, it has also not been possible to predict at an early stage which patients will develop significant radiographic damage of the spine over time and which patients will not. In the Outcome in Ankylosing Spondylitis International Study (OASIS)(5)(see below), the only variable with some prognostic ability regarding