血清陰性脊椎關節炎門診患者的臨床表現與藥物評估

Clinical disease pattern and drug evaluation of patients with seronegative spondyloarthritis at the outpatient department

目的：血清陰性脊椎關節炎包含了許多疾病在裡面。在本研究中，我們在門診中評估了血清陰性脊椎關節炎患者的疾病臨床表現與藥物使用情況。方法：我們在一個月內連續招募了共100位血清陰性脊椎關節炎患者。僵直性及椎炎的診斷是根據modified New York criteria，乾癬性關節炎的診斷是依據The ClASsification of Psoriatic Arthritis（CASPAR）criteria，而中軸性與周邊性脊椎關節炎則是依據new ASAS classification criteria。患者的基本資料、疾病活性與實驗室檢查均被完整評估。藥物的使用則主要包含非類固醇消炎藥與腫瘤壞死因子α阻斷劑。結果：在這一短期門診研究中，共有100位血清陰性脊椎關節炎患者被連續招募進來。當中男女比為2:1（男性67位，女性33位）。在這100位患者當中各疾病分佈為69位是僵直性脊椎炎，15位是乾癬性關節炎，12位是非影像學中軸性脊椎關節炎，4位是周邊性脊椎關節炎。虹彩炎是最常見關節以外的臨床表現。HLA-B27陽性的患者有較高的巴氏僵直性脊椎炎功能指數（BASFI）、巴氏僵直性脊椎炎疾病活性指數（BASDAI）與C反應蛋白。男性僵直性脊椎炎患者有較高的C反應蛋白與較嚴重的薦腸關節炎。接受抗腫瘤壞死因子α單株抗體治療的僵直性脊椎炎患者明顯有較高的巴氏僵直性脊椎炎功能指數與巴氏僵直性脊椎炎疾病活性指數。與非影像學中軸性脊椎關節炎患者相比，僵直性脊椎炎患者有較高巴氏僵直性脊椎炎功能指數、紅血球沉降速率與C反應蛋白，但巴氏僵直性脊椎炎疾病活性指數則沒有顯著差異。在非類固醇消炎藥的使用上，45%患者使用環氧化脢2抑制劑（celecoxib, etoricoxib），18%患者使用偏向環氧化酶2抑制劑（meloxicam），30%使用非選擇性環氧化脢2抑制劑（diclofenac, etodolac, naproxen），5%未使用非類固醇消炎藥。此外，在我們的脊椎關節炎患者當中有較高比例（33%）接受抗腫瘤壞死因子α抑制劑治療（etanercept 17, adalimumab 15, golimumab 1）。結論：在這個針對台灣脊椎關節炎患者的門診調查中，我們發現有不低比例的患者（16%）患有中軸性或周邊性脊椎關節炎。巴氏僵直性脊椎炎疾病活性指數在僵直性脊椎炎與非影像學中軸性脊椎關節炎這兩群患者間沒有顯著差異，也暗示當中軸性脊椎關節炎患者使用傳統非類固醇消炎藥治療無效時，抗腫瘤壞死因子α抑制劑治療是必須被考慮使用的。

Objective: There are a number of diseases in the spondyloarthritis (SpA) family. In this study, we evaluated the clinical disease pattern and drug use of outpatient department (OPD) patients with SpA. Methods: During a one-month period, we consecutively enrolled 100 patients with SpA. The diagnosis of ankylosing spondylitis (AS) was based on the modified New York criteria and that of psoriatic arthritis (PsA) followed The ClASsification of Psoriatic ARthritis (CASPAR) criteria. The new Assessment of SpondyloArthritis international Society (ASAS) classification criteria were used for the diagnosis of axial or peripheral SpA. Patients’ demographic characteristics, disease activity and laboratory tests were fully assessed. Medications currently used with the SpA family include non-steroidal anti-inflammatory drugs (NSAIDs) and TNF-α blockers. Results: A total of 100 SpA patients were consecutively enrolled in this short-term OPD survey. The male-to-female ratio of the enrolled patients was about 2:1 (66 males, 34 females). The clinical disease patterns of the 100 patients included 69 AS, 15 PsA, 12 non-radiographic axial SpA and 4 peripheral SpA. Uveitis was the most common extraarticular feature. Patients with positive HLA-B27 had higher Bath Ankylosing Spondylitis Functional Index (BASFI) scores, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores and CRP. Male AS patients seemed to have a higher CRP level and more severe sacroiliitis. AS patients receiving anti-TNFa therapy had significantly higher BASFI and BASDAI scores. AS patients had higher BASFI scores, and erythrocyte sedimentation rate (ESR) and CRP levels but no difference in BASDAI scores when compared to non-radiographic axial SpA patients. In terms of NSAIDs use, 45% of patients took cyclooxygenase-2 (COX-2) inhibitors (celecoxib, etoricoxib), 18% preferential COX-2 inhibitors (meloxicam), 30% nonselective NSAIDs (diclofenac, etodolac, naproxen), and 5% of patients used no NSAIDs. Besides, a higher percentage (33%) of our patients with SpA received regular anti-TNFα therapy (etanercept 17, adalimumab 15, golimumab 1). Conclusion: This OPD survey of Taiwan SpA patients disclosed not a small percentage (16%) of Taiwan SpA patients had either axial or peripheral SpA. The lack of significant difference in the BASDAI between AS and axial SpA suggests anti-TNFα therapy is indicated when traditional NSAIDs fail in axial SpA patients.