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Enthesitis in patients with psoriatic arthritis: A nationwide data from the Chinese Registry of Psoriatic Arthritis (CREPAR)
编辑人员丨1周前
Background::The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts.Methods::Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts.Results::In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0–18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59–3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01–1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01–1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs’ (csDMARDs) use. Conclusions::Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.
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编辑人员丨1周前
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C反应蛋白水平与有薪工作的强直性脊柱炎患者工作能力损失的相关性研究初探:基于脊柱关节炎智能移动管理系统的真实世界数据
编辑人员丨1周前
利用真实世界数据探究C反应蛋白(CRP)与强直性脊柱炎(AS)患者工作能力损失的相关性。采用脊柱关节炎智能管理系统(SpAMS)连续收录2016年4月至2018年4月解放军总医院第一医学中心确诊为AS的患者,评估CRP与工作效率及活动障碍调查问卷(WPAI)中因病缺勤时间比、疾病相关工作效率损失比、总工作生产力损失比和疾病对日常活动影响比的相关性。共纳入551例有薪工作的AS患者,患者既往7 d因病缺勤时间比为(11.0±25.1)%,疾病相关工作效率损失比为(23.9±20.3)%,总工作生产力损失比为(30.9±27.5)%,疾病对日常活动影响比为(25.6±21.9)%。与CRP≤3.17 mg/L者比,CRP>3.17~≤11.30 mg/L者、CRP>11.30 mg/L者病程更长,强直性脊柱炎病情活动度评分(ASDAS)、Bath强直性脊柱炎疾病活动度评分(BASDAI)、Bath强直性脊柱炎功能指数(BASFI)、Bath强直性脊柱炎计量指数(BASMI)更高,疾病相关工作效率损失比、总工作生产力损失比和疾病对日常活动影响比更大,接受肿瘤坏死因子α(TNFα)抑制剂和传统中药治疗者更多。多因素分析显示,基线CRP每升高10 mg/L,疾病相关工作效率损失比升高1.4%(1.1%~1.8%),总工作生产力损失比升高1.1%(0.5%~1.6%),疾病对日常活动影响比升高1.7%(1.3%~2.1%)( P值均<0.05)。工作的AS患者,基线CRP水平越高,疾病对患者既往7 d工作效率、总生产力和日常活动的影响越大,提示治疗随访中监测CRP水平非常重要,抗炎治疗可能对提高AS患者工作能力有益。
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编辑人员丨1周前
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强直性脊柱炎的免疫学研究进展
编辑人员丨1周前
强直性脊柱炎(AS)是以骶髂关节和脊柱附着点炎症为特征的慢性炎症性疾病,是脊柱关节病最常见的类型。骨细胞与免疫细胞相互作用,分泌一系列的炎症因子,共同调控AS的发病。AS中各种免疫细胞的失调、炎症细胞因子的改变导致骨代谢紊乱,同时骨细胞表达各种炎症细胞因子,导致免疫系统失调。免疫系统与骨骼系统的相互作用已成为AS发病机制研究的热点,了解AS的骨免疫学机制将有助于更好地了解AS的确切发病机制并探索AS的新治疗方法。综述了AS中免疫细胞和炎症细胞因子的改变及其对骨骼系统的影响,以及骨骼系统中各种骨细胞的改变及其对免疫系统的影响,同时总结了AS的治疗进展。
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编辑人员丨1周前
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Etanercept in axial spondyloarthritis
编辑人员丨1周前
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编辑人员丨1周前
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非放射学中轴型脊柱关节炎的概念与正确认识
编辑人员丨1周前
因国际脊柱关节炎评估协会发表了中轴型脊柱关节炎(axSpA)的分类标准而出现了一个新的疾病名称“non-radiographic axial spondyloarthritis(nr-axSpA)”,国内有专家将其译为“放射学阴性”axSpA,但从字面上容易导致误解,因为并非所有nr-axSpA患者完全无放射学异常。本文简述了axSpA这一概念问世的历史沿革,提出nr-axSpA应直译为“非放射学”axSpA 的建议;阐述非放射学axSpA和放射学阴性axSpA的异同点;分析非放射学axSpA与早期强直性脊柱炎的相互关系;指出国际脊柱关节炎评估协会关于axSpA的分类标准之特异性并不高,尤其是那些“符合该标准的非放射学axSpA”并不一定都是真正的非放射学axSpA,提醒国内同道易发生误诊的5种常见场景。
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编辑人员丨1周前
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Coxitis in axial spondyloarthritis: the unmeasured, yet functionally most important, radiographic progression
编辑人员丨1周前
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编辑人员丨1周前
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不同性别成人发病放射学阴性中轴型脊柱关节炎的临床特点比较
编辑人员丨1周前
目的:了解不同性别成人发病放射学阴性中轴型脊柱关节炎(nr-axSpA)的临床特点。方法:本研究纳入1999—2020年就诊于汕头大学医学院第一附属医院的成人发病(发病年龄≥16岁)nr-axSpA患者662例,分析其不同性别之间人口学特征及临床特点的差异。结果:本组nr-axSpA患者男女性别比例为1.17∶1,HLA-B27阳性率71.8%(475/662),基线病程中位数1.6(0.5,4.0)年,就诊年龄中位数25.0(21.0,33.0)岁。男性与女性相比,发病年龄及初诊年龄更低[21.0(18.0,28.0)岁和25.0(21.0,30.0)岁, Z=5.63, P<0.001;24.0(19.0,32.0)岁和27.0(23.0,34.5)岁, Z=4.91, P<0.001],HLA-B27阳性率更高[(78.4%(280/357)和63.9%(195/305), χ2=17.06, P<0.001]。男性患者炎性腰背痛(IBP)、晨僵、夜间痛、附着点炎、髋痛、腹股沟痛的发生率比女性更高,而手小关节受累在女性患者中更常见,差异有统计学意义。初诊时,男性与女性相比,强直性脊柱炎疾病活动度评分(ASDAS)-CRP评分更高[3.0(2.3,3.8)和2.4(2.0,3.0), Z=5.59, P<0.001],病情活动者(ASDAS-CRP>2.1)的比例更高[81.9%(185/226)和67.9%(133/196), χ2=11.08, P=0.001],CRP和ESR升高的比例更高[49.0%(175/357)和27.9%(85/305), χ2=30.85, P<0.001;49.3%(176/357)和33.4%(102/305), χ2=16.98, P<0.001]。 结论:中国成人发病nr-axSpA患者的性别比例接近,男性患者较女性更早发病,HLA-B27阳性率更高,IBP、附着点炎、髋和腹股沟痛更常见,病情活动度更高,而手小关节受累在女性患者中更常见。
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编辑人员丨1周前
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重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白致药疹2例
编辑人员丨1周前
2例患者(例1女,59岁;例2女,67岁)分别因中轴型脊柱关节炎和类风湿关节炎应用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(rhTNFR:Fc)治疗。例1接受rhTNFR:Fc 50 mg皮下注射、1次/周。治疗3次后双侧上臂出现粟粒大小红色丘疹,伴瘙痒,自行停用rhTNFR:Fc后皮疹减轻;2周后再次使用rhTNFR:Fc,双侧上臂红色丘疹复现并加重,肩背部出现粟粒大小红色丘疹,左踝部出现水肿性红斑,考虑为rhTNFR:Fc所致药疹,停用该药,给予抗过敏治疗10 d后皮疹减轻,1月后皮疹消退。例2接受rhTNFR:Fc 50 mg皮下注射、1次/周,治疗4次后左下肢出现散在的黄豆大小红色丘疹,此后丘疹面积逐渐增大并出现脱屑,考虑为rhTNFR:Fc所致。停用该药,给予糖皮质激素和其他抗风湿药物及补钙等治疗,14 d后丘疹基本消退。
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编辑人员丨1周前
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Risk of infections of biological and targeted drugs in patients with spondyloarthritis: meta-analysis of randomized clinical trials
编辑人员丨1周前
Background::Concerns exist regarding the risk of infections in patients with spondyloarthritis (SpA) treated with biologics. We assessed the risk of infections of biological and targeted drugs in patients with SpA by performing a meta-analysis based on randomized controlled trials (RCTs).Methods::A systematic literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, and China Biology Medicine Disc for RCTs evaluating the risk of infections of biological therapy in patients with SpA from inception through August 9, 2021. We calculated a pooled Peto odds ratio (OR) for infections in biologics-treated patients vs. placebo patients. The risk of bias on the included RCTs was assessed by using the Cochrane Risk of Bias Tool. Results::In total, 62 studies were included in this meta-analysis. Overall, the risk of infection (Peto OR: 1.16, 95% confidence interval [CI]: 1.07-1.26, P < 0.001), serious infection (Peto OR: 1.65, 95% CI: 1.26-2.17, P < 0.001), upper respiratory tract infection (URTI) (Peto OR: 1.17, 95% CI: 1.04-1.32, P = 0.008), nasopharyngitis (Peto OR: 1.25, 95% CI: 1.10-1.42, P < 0.001), and Candida infection (Peto OR: 2.64, 95% CI: 1.48-4.71, P = 0.001) were increased in SpA patients treated with biologics compared with placebo. Sensitivity analysis based on biologics classes was conducted, and results demonstrated that compared with placebo, there was a higher risk of infection for tumor necrosis factor (TNF)-α inhibitors (Peto OR: 1.38, 95% CI: 1.13-1.68, P = 0.001) and interleukin (IL)-17 inhibitors (Peto OR: 1.55, 95% CI: 1.08-2.22, P = 0.018) in axial SpA, and for Janus kinase inhibitors in peripheral SpA (Peto OR: 1.39, 95% CI: 1.14-1.69, P = 0.001); higher risk of serious infection for IL-17 inhibitors in peripheral SpA (Peto OR: 3.46, 95% CI: 1.26-9.55, P = 0.016) and axial SpA (Peto OR: 2.01, 95% CI: 1.38-2.91, P < 0.001); higher risk of URTI for TNF-α inhibitors in axial SpA (Peto OR: 1.37, 95% CI: 1.05-1.78, P= 0.019), and for apremilast in peripheral SpA (Peto OR: 1.60, 95% CI: 1.08-2.36, P = 0.018); higher risk of nasopharyngitis for TNF-α inhibitors in axial SpA (Peto OR: 1.41, 95% CI: 1.05-1.90, P = 0.022) and peripheral SpA (Peto OR: 1.49, 95% CI: 1.09-2.05, P = 0.013), and for IL-17 inhibitors in axial SpA (Peto OR: 1.35, 95% CI: 1.01-1.82, P = 0.044); higher risk of herpes zoster for Janus kinase inhibitors in peripheral SpA (Peto OR: 2.18, 95% CI: 1.03-4.62, P = 0.043); higher risk of Candida infection for IL-17 inhibitors in peripheral SpA (Peto OR: 2.52, 95% CI: 1.31-4.84, P= 0.006). Conclusions::This meta-analysis shows that biological therapy in patients with SpA may increase the risk of infections, including serious infections, URTI, nasopharyngitis, and Candida infection, which should be paid attention to in our clinical practice.
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编辑人员丨1周前
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中轴型脊柱关节炎骶髂关节MRI评估
编辑人员丨1周前
中轴型脊柱关节炎(axial spondyloarthritis,ax-SpA)是一组慢性炎症性疾病,根据放射学改变分为强直性脊柱炎和放射学阴性ax-SpA,早期症状主要为炎性腰背痛,漏误诊或延迟诊断可致患者病情和残疾程度加重。MRI是ax-SpA诊疗过程中重要辅助手段,且是发现活动性病变的主要影像技术,可用于早期诊断及鉴别诊断。该文中重点阐述ax-SpA骶髂关节活动性和结构性征象的MRI评估,旨在提高放射科医师和风湿免疫科医师对ax-SpA骶髂关节的影像认识,从而更好地诊断、鉴别诊断。
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编辑人员丨1周前
