腫瘤壞死因子抑製劑降低類風濕關節炎手骨關節炎的惡化

腫瘤壞死因子抑製劑降低類風濕關節炎患者十年後手骨關節炎的惡化風險

腫瘤壞死因子抑製劑降低

類風濕關節炎患者十年後

手骨關節炎的惡化風險

目 標

隨訪十年，研究腫瘤壞死因子抑製劑（TNFi）對新發類風濕關節炎(RA)患者新出現手骨關節炎（OA）及病情進展的影響。

方 法

本研究覆蓋262名來自BeSt研究的RA患者（平均年紀52歲，其中66%為女性），在基線期和10年隨訪期間，根據國際骨關節炎研究學會評分（0-3；總分0-54）和Kellgren-Lawrence(KL)評分 (0-3；總分0-72）對其遠端/近端指關節骨贅進行評分。每三個月對TNFi治療進行評估。使用廣義線性模型和廣義估計方程對TNFi治療和手OA之間的關係分別從患者和關節兩方面進行分析。

結 果

58%的患者接受了TNFi治療，治療持續時間的中位數為42個月。根據國際骨關節炎研究學會的骨贅評分結果，共143名患者（55%）在基線期有手部指間關節OA。在患者層面，TNFi治療持續時間未影響手部OA發生。但TNFi治療/月可使手OA的遠端指間關節（DIP）病變進展的相對風險（RR）降低【相對風險（RR）0.987（95% CI 0.987，0.996）】，而不影響近端指間關節(PIP)病變。在關節層面，本研究觀察到TNFi對手OA DIP進展有效【RR 0.996（95% CI 0.991，1.000）】，而不影響PIP。KL評分分析結果與骨贅評分相近。

結 論

TNFi治療降低10年後手部OA的DIP影像學進展風險，但與PIP的影像學惡化無關。雖然這一效應量較小，但提示TNF-α在手OA發病機制中有作用。

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.

文章出處：

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)

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