NSAIDs以優(yōu)化劑量治療中軸型SpA：聚焦6周期間骶髂關(guān)節(jié)MRI變化

PresentID: OP0170

原文

TREATMENTOF AXIAL SPONDYLOARTHRITIS WITH AN OPTIMAL DOSAGE OF NSAIDS: A 6-WEEK FOLLOW UPSTUDY FOCUSING ON MAGNETIC RESONANCE IMAGING OF THE SACROILIAC JOINTS.

G. Varkas1,*, H. Cypers1, L. VanPraet1, L. Jans2, P. Carron1, D. Elewaut1, F. Van den Bosch1

1Rheumatology, 2Radiology, GhentUniversity Hospital, Ghent, Belgium

Background: In contrast to the establishedefficacy of anti- tumor necrosis factor α (TNFα) on BME of the sacroiliacjoints (SIJ) (and spine), surprisingly little information exists on the impactof NSAIDs. As NSAID therapy was already the cornerstone of treatment beforemagnetic resonance imaging of the SIJ was introduced, very limited data on theeffect of optimal NSAID therapy on the extent of inflammation, quantified by avalidated score such as the Spondyloarthritis Research Consortium of Canada(SPARCC) scoring system, has been published. Our goal was therefore to examinethe impact of NSAID use on disease activity and BME in an inception cohort ofnew onset AxSpA.

Objectives: To evaluate the impact of fulldose NSAIDs on the extent and intensity of bone marrow edema of the sacroiliacjoints on magnetic resonance imaging in axial spondyloarthritis (AxSpA).

Methods: A single center, 6-week study ina consecutive cohort of patients with clinical suspicion of AxSpA. A total of 102 patients werescreened. Thirtysix patients with diagnosis of AxSpA and positive MRI SIJ were includedfor a follow-up MRI after 6 weeks of optimal dose of NSAIDs. Disease activitywas monitored by a BASDAI questionnaire every 2 weeks and BASFI at baseline andweek 6. NSAID intake was assessed by the ASAS NSAID-index. Primary endpointswere BASDAI response and improvement of the Spondyloarthritis Research Consortium of Canada(SPARCC) score of MRI SIJ at week 6.

Results: About 38.5% of AxSpA patients was unable to continuethe full dose NSAID schedule. Sixteen patients abided completely by theprotocol. Median NSAID Index reached 97%. We calculated a mean decrease of 0.4in BASDAI score per 2 weeks of therapy (P<0.001). Only 18.75% of patients(3/16) reached a BASDAI50 response at week 6. Overall, we found an 8% reductionin mean SPARCC scores at week 6 in comparison to baseline (P=0.046). Fiftypercent of patients (8/16) displayed high intensity lesions on STIR atbaseline, which decreased significantly at week 6 (P=0.043).

Conclusions: We found a marginal decrease inbone marrow edema of the sacroiliac joints after 6 weeks of optimal NSAIDtherapy in newly presenting patients with axial spondyloarthritis and a high level of drop out inpatients on NSAID therapy in addition to low BASDAI 50 response.

譯文

背景：TNF-α拮抗劑對(duì)骶髂關(guān)節(jié)(SIJ)（以及脊柱）的骨髓水腫(BME)的療效眾所周知，而NSAIDs對(duì)其影響的研究卻少的驚人。在SIJ MRI引進(jìn)以前，NSAID已經(jīng)是治療axSpA的主要手段，但極少見到文獻(xiàn)報(bào)道采用諸如已經(jīng)驗(yàn)證的加拿大SpA研究協(xié)會(huì)(SPARCC)評(píng)估系統(tǒng)對(duì)NSAIDs抑制中軸炎癥進(jìn)行評(píng)價(jià)。因此，本研究目標(biāo)是檢驗(yàn)NSAID對(duì)新發(fā)axSpA的疾病活動(dòng)以及和BME的影響。目的：評(píng)估全劑量的NSAIDs影響ax-spa骶髂關(guān)節(jié)骨髓水腫（基于MRI）的程度和強(qiáng)度。

方法：單中心對(duì)連續(xù)收治的疑診axSpA的患者隊(duì)列進(jìn)行為期6周的觀察。共篩選102位患者，36位診斷為axSpA且MRI 骶髂關(guān)節(jié)炎陽(yáng)性的患者在最佳劑量NSAIDs治療6周后復(fù)查MRI。疾病活動(dòng)度監(jiān)測(cè)包括每2周評(píng)估一次BASDAI，基線和第6周評(píng)估BASFI。用ASAS NSAID指數(shù)評(píng)估NSAID服用量。主要研究終點(diǎn)是第6周的BASDAI評(píng)分和SIJ MRI SPARCC評(píng)分改善。

結(jié)果：約38.5％axSpA患者無法完成NSAID足量治療計(jì)劃，16例患者完全遵從研究方案。約97%患者使用了中等NSAID劑量。我們計(jì)算發(fā)現(xiàn)BASDAI每2周平均減少0.4（P < 0.001）。第6周BASDAI50達(dá)標(biāo)率只有18.75％（3/16）。總體而言，第6周SPARCC自基線平均降幅為8％（P=0.046 ）?；€STIR序列呈高信號(hào)的患者比例為15%（8/16）， 第6周時(shí)有明顯下降（P=0.043）。

結(jié)論：本研究發(fā)現(xiàn)以優(yōu)化劑量NSAID治療6周對(duì)新近發(fā)病axSpA骶髂關(guān)節(jié)骨髓水腫抑制作用輕微，BASDAI50達(dá)標(biāo)率較低，僅使用NSAID的脫落率較高。