强直性脊柱炎伴两种或两种以上生物疾病无效的临床特征改变抗风湿药物

S. Erdes, K. Sakharova, T. Dubinina, M. Cherkasova
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摘要

轴性脊柱炎(axSpA)的“治疗到目标”(T2T)策略使大多数患者的治疗最优化成为可能,但其中一些患者的治疗目标没有实现。目的:分析强直性脊柱炎(AS)合并两种及以上生物疾病修饰抗风湿药物(bDMARDs)无效患者的临床特点。材料和方法。从2020年2月到2022年3月,458名符合1984年修改后的纽约标准的AS患者被va Nasonova风湿病研究所收治。从该组中选择30例(6.6%)临床疾病活动性高且至少两种bdmard无效的患者。对照组包括139例(30.5%)AS患者,他们要么没有使用bdmard的历史,要么以前只接受过其中一种。所有患者均按照普遍接受的方法进行检查,并进行双专家对照。结果和讨论。男性在主要组和对照组中占主导地位(分别为67%和60%)。在主组患者中,疾病的实验室活动性较高,特别是ESR (p=0.002),更常检测到周围性关节炎。两组髋关节炎的发生率均较高(分别为69.2和69.7%),而主组行全关节置换术的患者明显较多,并发症状的出现频率较对照组低2倍。AS发病特征的差异也被确定:在主要组中,疾病通常以反应性关节炎(ReA)开始,而在对照组中,疾病以炎症性背痛开始。axSpA的T2T策略并不总是导致预期目标的实现,根据我们的数据,在AS住院患者中,有两种或两种以上bdmard无效史的人数达到6%。在这些患者中,与对照组相比,疾病的以下特征可以区分:频繁发作ReA,外周关节炎和关节置换术的发生率显著,ESR较高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical features of patients with ankylosing spondylitis with inefficacy of two or more biological disease modifying antirheumatic drugs
The “Treat-to-target” (T2T) strategy for axial spondyloarthritis (axSpA) has made it possible to optimize therapy in most patients, but in some of them the treatment goals are not achieved.Objective: to analyze the clinical features of patients with ankylosing spondylitis (AS) with inefficacy of two or more biological disease modifying antirheumatic drugs (bDMARDs).Material and methods. From February 2020 to March 2022 458 patients with AS, who met the modified New York criteria of 1984, were admitted to V.A. Nasonova Research Institute of Rheumatology. From this group, 30 (6.6%) patients with high clinical disease activity and inefficacy of at least two bDMARDs were selected. The control group consisted of 139 (30.5%) patients with AS, who either had no history of bDMARDs use, or had previously received only one of them. All patients were examined in accordance with generally accepted methods and underwent a double expert control.Results and discussion. Men predominated in the main and control groups (67 and 60%, respectively). In patients of the main group, there was a higher laboratory activity of the disease, especially ESR (p=0.002), more often peripheral arthritis was detected. In both groups, there was a high incidence of coxitis (69.2 and 69.7%, respectively), while in the main group there were significantly more patients who underwent total joint arthroplasty, and the frequency of detected syndesmophytes was 2 times lower compared to the control. Differences in the features of AS onset were also established: in the main group, the disease often began with reactive arthritis (ReA), while in the control group, with inflammatory back pain.Conclusion. The T2T strategy in axSpA does not always lead to the achievement of the intended goals, and, according to our data, among inpatients with AS, the number of people with a history of inefficacy of two or more bDMARDs reaches 6%. In these patients, compared with the control, the following features of the disease can be distinguished: frequent onset with ReA, a significant incidence of peripheral arthritis and joint arthroplasty, and a higher ESR.
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