肿瘤坏死因子抑制剂降低类风湿关节炎手骨关节炎的恶化

肿瘤坏死因子抑制剂降低类风湿关节炎患者十年后手骨关节炎的恶化风险

肿瘤坏死因子抑制剂降低

类风湿关节炎患者十年后

手骨关节炎的恶化风险

目 标

随访十年，研究肿瘤坏死因子抑制剂（TNFi）对新发类风湿关节炎(RA)患者新出现手骨关节炎（OA）及病情进展的影响。

方 法

本研究覆盖262名来自BeSt研究的RA患者（平均年纪52岁，其中66%为女性），在基线期和10年随访期间，根据国际骨关节炎研究学会评分（0-3；总分0-54）和Kellgren-Lawrence(KL)评分 (0-3；总分0-72）对其远端/近端指关节骨赘进行评分。每三个月对TNFi治疗进行评估。使用广义线性模型和广义估计方程对TNFi治疗和手OA之间的关系分别从患者和关节两方面进行分析。

结 果

58%的患者接受了TNFi治疗，治疗持续时间的中位数为42个月。根据国际骨关节炎研究学会的骨赘评分结果，共143名患者（55%）在基线期有手部指间关节OA。在患者层面，TNFi治疗持续时间未影响手部OA发生。但TNFi治疗/月可使手OA的远端指间关节（DIP）病变进展的相对风险（RR）降低【相对风险（RR）0.987（95% CI 0.987，0.996）】，而不影响近端指间关节(PIP)病变。在关节层面，本研究观察到TNFi对手OA DIP进展有效【RR 0.996（95% CI 0.991，1.000）】，而不影响PIP。KL评分分析结果与骨赘评分相近。

结 论

TNFi治疗降低10年后手部OA的DIP影像学进展风险，但与PIP的影像学恶化无关。虽然这一效应量较小，但提示TNF-α在手OA发病机制中有作用。

原 文

TNF inhibitor treatment is associated with a lower risk of hand osteoarthritis progression in rheumatoid arthritis patients after 10 years

Objective

To investigate the effect of TNF inhibitors (TNFis) on incidental and progressive hand OA in recent-onset RA patients after a 10 year follow-up.

Methods

Radiographs of 262 RA patients (mean age 52 years, 66% women) from the BeSt study were scored for osteophytes in DIP/PIP joints using the Osteoarthritis Research Society International atlas (0–3; summed score 0–54) and according to the Kellgren–Lawrence (KL) score (0–4; summed score 0–72) at baseline and 10 year follow-up. TNFi treatment was assessed on visits every 3 months. Associations between TNFi treatment and hand OA were analysed on the patient and joint level using generalized linear models and generalized estimating equations, respectively.

Results

Fifty-eight percent of the patients were treated with TNFi, with a median duration of 42 months. A total of 143 patients (55%) had hand OA in any IP joint at baseline based on the Osteoarthritis Research Society International osteophyte score. On the patient level, TNFi treatment duration did not affect incidental hand OA. However, every month of TNFi treatment resulted in a reduced relative risk (RR) of hand OA progression in DIP joints [relative risk (RR) 0.987 (95% CI 0.978, 0.996)] but not in PIP joints. On the joint level, the effect on hand OA progression was observed in DIP joints [RR 0.996 (95% CI 0.991, 1.000)] but not in PIP joints. The results from the KL score analyses were comparable to the osteophyte score.

Conclusion

TNFi treatment was associated with a reduced risk on radiographic hand OA progression in DIP joints but not in PIP joints after 10 years. Although the effect sizes are small, these results provide evidence for influence of TNF-α in hand OA pathogenesis.

文章出处：

Marieke Loef, Féline P B Kroon, Sytske Anne Bergstra, Joy A van der Pol, Willem F Lems, Pit J S M Kerstens, Cornelia F Allaart, Margreet Kloppenburg. Rheumatology, key016,https://doi.org/10.1093/rheumatology/key016 (19-Feb-18)