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The Degree of Spinal Inflammation Is
Similar in Patients with Axial Spondyloarthritis Who Report High or
Low Levels of Disease Activity – a Cohort Study
Uta Kiltz
1, Xenofon Baraliakos1,
Pantelis Karakostas1, Manfred Igelmann2,
Ludwig H. Kalthoff3, Claudia Klink4, Dietmar
MJ Krause4, Elmar Schmitz-Bortz5, Martina
Floerecke1, Matthias Bollow6 and Juergen
Braun1, 1Ruhr-University Bochum, Herne,
Germany, 2Private Rheumatology office, Bochum, Germany,
3Private rheumatology office, Herne, Germany,
4Private rheumatology office, Gladbeck, Germany,
5Private rheumatology office, Hattingen, Germany,
6Augusta Krankenanstalten, Bochum,
Germany
Presentation
Number: 503
Background/Purpose: Patients with
axial spondyloarthritis (axSpA) may already have established
radiographic changes in the sacroiliac joints, classified as
ankylosing spondylitis (AS) or non-radiographic axial SpA
(nraxSpA). International recommendations for the management of
axSpA have set the cut off for the minimal clinical disease
activity required to fulfill criteria for anti-TNF therapy at a
BASDAI level of 4 - based on a convention arbitrarily proposed some
years ago. However, the level of inflammatory activity as
demonstrated by magnetic resonance imaging (MRI) or elevated CRP
levels in patients who report moderate disease activity is unknown.
The objective of this study was to systematically compare the
clinical, laboratory and imaging data of patients with axSpA,
stratified by the level of disease activity: BASDAI
<4 and ≥4
Method: A total of 100
consecutive patients with axSpA who had never been treated with
TNF-blockers were included. Data on demographics (gender, age,
symptom duration, comorbidities, use of concomitant medication)
were collected, and standardized assessment tools (BASDAI, BASFI,
ASDAS, NRS pain, physicians´s and patient´s global assessment,
ASQoL, SF-36) applied, laboratory parameters (CRP, HLA-B 27 status)
measured, and spinal MRI and x-rays performed and quantified with
established scoring systems (mSASSS, RASSS and Berlin score). Data
were stratified according to the correspondent BASDAI level ≥4 or
<4
Result: AS was diagnosed
in 56 and nraxSpA in 44 patients, mean age 40.2±10.4 years; 57%
male, mean disease duration 6.4±8.4y, 88% HLA-B27 positivity.
Almost all patients took NSAIDs (94%), 54% continuously. More than
half of the patients had spinal inflammation to some degree (60%).
The stratification based on BASDAI levels showed statistically
significant differences in most clinical parameters - but not for
inflammation as measured by either CRP or MRI: nraxSpA patients
with BASDAI <4 versus (vs) ≥4 had 0.9±1.4 and
0.5±0.6 inflammatory lesions/patient, respectively (p=0.6), while
AS patients with BASDAI <4 vs ≥4 had 3.6±3.7 and
2.7±3.0 inflammatory lesions/patient, respectively
(p=0.4).
Conclusion: The striking
result of this study in patients with axSpA is
that there is not only no correlation between widely used clinical
assessments of disease activity and more objective measurements of
inflammation such as CRP serum levels and MRI but that the BASDAI
cut-off ≥ 4 needs to be reevaluated. These data clearly challenge
the concept of the arbitrarily set clinical cut off BASDAI≥4
since the burden of inflammation and most clinical
measures were quite comparable in patients with nraxSpA and
established AS - irrespective of BASDAI levels. These data confirm
and justify the inclusion of patients with nraxSpA in the recent
recommendations for anti-TNF therapy.
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脊柱炎症水平在疾病活动度高低不等的脊柱关节炎患者中表现相似－来自一项群体研究结果
Uta Kiltz , et al. ACR 2011. Present
No: 503
背景/目的:中轴脊柱关节炎患者(axSpA)可以有明确的骶髂关节影像学改变并被分类为强直性脊柱炎(AS)或无影像学的中轴SpA(nraxSpA)。国际上对axSpA的治疗建议已经将需要anti-TNF治疗的临床活动度最低点设为BASDAI水平的4
, 这是基于数年前的一项讨论提意。然而, 疾病中度活动的患者核磁共振成像(MRI)上表现的炎症或CRP升高的水平尚不得知。本研究的目的是系统比较axSpA疾病活动度BASDAI
< 4和≥4的患者在临床、实验室及影像学数据上的差异。
方法:共有100例 从来没有接受TNF阻断剂治疗的axSpA患者连续入组。 收集人口统计学数据(性别、年龄、病程、并发症、伴随药应用),测定标准化的评估工具(BASDAI,BASFI,ASDAS NRS疼痛,患者和医生总体评估,ASQoL,SF-36),检测实验室指标(CRP,HLA-B 27情况),同时行脊柱MRI和x线检查并通过已有的积分系统进行量化(mSASSS,RASSS和Berlin积分)。根据数据按照 BASDAI水平≥4 或<4对病人进行分层。
结果:56例AS和44例nraxSpA患者，,平均年龄为40.2±10.4岁,男性57%,平均病程8.4±6.4
y,88% HLA-B27阳性。几乎所有的患者都服用过非甾体类抗炎药(94%),54%仍在继续。超过一半的患者在某种程度上有脊柱炎症(60%)。基于BASDAI水平的分层显示两组患者在大多数临床参数统计上有显著差异，但不包括MRI检查或CRP测量的炎症:nraxSpA 患者BASDAI < 4和≥4相比，每个患者的炎症损伤分别为0.9 ±1.4和0.5±0.6(p = 0.6),而AS患者中BASDAI
< 4和≥4相比，每个患者的炎症损伤则分别为
3.6±3.7和2.7±3.0 (p = 0.4)。
结论:这项axSpA研究引人注目的结果在于，不仅广泛应用的临床评估活动的指标与客观的炎症测量值如血清CRP炎症和MRI无明显相关性，而且作为界限的BASDAI≥ 4 需要被重新判定。 不论BASDAI水平如何,
nraxSpA和明确的AS患者之间炎症的程度和大部分临床指标都非常相似，这些数据明显挑战了任意设定的临床临界概念BASDAI≥4。这些数据也验证和证实了包括nraxSpA患者在内的最近anti-TNF治疗建议。
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