NSAIDs以优化剂量治疗中轴型SpA：聚焦6周期间骶髂关节MRI变化

PresentID: OP0170

 

TREATMENT OF AXIAL SPONDYLOARTHRITIS WITH AN OPTIMAL DOSAGE OF NSAIDS: A 6-WEEK FOLLOW UP STUDY FOCUSING ON MAGNETIC RESONANCE IMAGING OF THE SACROILIAC JOINTS. G. Varkas1,*, H. Cypers1, L. Van Praet1, L. Jans2, P. Carron1, D. Elewaut1, F. Van den Bosch1 1Rheumatology, 2Radiology, Ghent University Hospital, Ghent, Belgium   Background: In contrast to the established efficacy of anti- tumor necrosis factor α (TNFα) on BME of the sacroiliac joints (SIJ) (and spine), surprisingly little information exists on the impact of NSAIDs. As NSAID therapy was already the cornerstone of treatment before magnetic resonance imaging of the SIJ was introduced, very limited data on the effect of optimal NSAID therapy on the extent of inflammation, quantified by a validated score such as the Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system, has been published. Our goal was therefore to examine the impact of NSAID use on disease activity and BME in an inception cohort of new onset AxSpA. Objectives: To evaluate the impact of full dose NSAIDs on the extent and intensity of bone marrow edema of the sacroiliac joints on magnetic resonance imaging in axial spondyloarthritis (AxSpA). Methods: A single center, 6-week study in a consecutive cohort of patients with clinical suspicion of AxSpA. A total of 102 patients were screened. Thirtysix patients with diagnosis of AxSpA and positive MRI SIJ were included for a follow-up MRI after 6 weeks of optimal dose of NSAIDs. Disease activity was monitored by a BASDAI questionnaire every 2 weeks and BASFI at baseline and week 6. NSAID intake was assessed by the ASAS NSAID- index. Primary endpoints were 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 continue the full dose NSAID schedule. Sixteen patients abided completely by the protocol. Median NSAID Index reached 97%. We calculated a mean decrease of 0.4 in BASDAI score per 2 weeks of therapy (P<</em>0.001). Only 18.75% of patients (3/16) reached a BASDAI50 response at week 6. Overall, we found an 8% reduction in mean SPARCC scores at week 6 in comparison to baseline (P=0.046). Fifty percent of patients (8/16) displayed high intensity lesions on STIR at baseline, which decreased significantly at week 6 (P=0.043). Conclusions: We found a marginal decrease in bone marrow edema of the sacroiliac joints after 6 weeks of optimal NSAID therapy in newly presenting patients with axial spondyloarthritis and a high level of drop out in patients on NSAID therapy in addition to low BASDAI50 response.

背景：TNF-α拮抗剂对骶髂关节(SIJ)（以及脊柱）的骨髓水肿(BME)的疗效众所周知，而NSAIDs对其影响的研究却少的惊人。在SIJ MRI引进以前，NSAID已经是治疗axSpA的主要手段，但极少见到文献报道采用诸如已经验证的加拿大SpA研究协会(SPARCC)评估系统对NSAIDs抑制中轴炎症进行评价。因此，本研究目标是检验NSAID对新发axSpA的疾病活动以及和BME的影响。 目的：评估全剂量的NSAIDs影响ax-spa骶髂关节骨髓水肿（基于MRI）的程度和强度。 方法：单中心对连续收治的疑诊axSpA的患者队列进行为期6周的观察。共筛选102位患者，36位诊断为axSpA且MRI骶髂关节炎阳性的患者在最佳剂量NSAIDs治疗6周后复查MRI。疾病活动度监测包括每2周评估一次BASDAI，基线和第6周评估BASFI。用ASAS NSAID指数评估NSAID服用量。主要研究终点是第6周的BASDAI评分和SIJ MRI SPARCC评分改善。 结果：约38.5％axSpA患者无法完成NSAID足量治疗计划，16例患者完全遵从研究方案。约97%患者使用了中等NSAID剂量。我们计算发现BASDAI每2周平均减少0.4（P < 0.001）。第6周BASDAI50达标率只有18.75％（3/16）。总体而言，第6周SPARCC自基线平均降幅为8％（P=0.046）。基线STIR序列呈高信号的患者比例为15%（8/16），第6周时有明显下降（P=0.043）。 结论：本研究发现以优化剂量NSAID治疗6周对新近发病axSpA骶髂关节骨髓水肿抑制作用轻微，BASDAI50达标率较低，仅使用NSAID的脱落率较高。