ABSTRACT
Objective To investigate the recurrence rate of patients with axial spondyloarthritis (ax-SpA) treated with etanercept (ETN) combined with non-steroidal anti-inflammatory drugs (NSAIDs) and to explore its related risk factors. Methods A total of 125 patients with ax-SpA, who responded poorly to NSAIDs, were treated additionally with ETN (50 mg per week) for 12 weeks and simultaneously received original dosage of NSAIDs. We recorded the baseline data, including age, gender, disease duration and grading of sacroiliac joint X-ray, formation of syndesmophyte; and we analyzed the changes of the remission and recurrence conditions, Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR) and adverse events in the follow-up from week 0 to week 48. Risk factors of relapse after ETN withdrawl in patients withax-SpA were analyzed using binary logistic regression model and Cox regression model. Results Before treatment, 28 (22.4%) patients showed syndesmophyte formation and 58 (46.4%) had graded 3 X-ray sacroiliac joint classification. After continuous treatment with ETN for 12 weeks, 120(96.0%) patients achieved clinical remission, with BASDAI, BASFI, ESR and CRP decreasing significantly (P<0.05). Within 48 weeks of follow-up, 29 (23.2%) patients had relapse, and the maintenance of remission lasted for (36.8 ± 12.3) weeks. Binary logistic regression model analysis showed that syndesmophyte formation was a risk factor of relapse (OR = 70, P〈0.001). Cox regression model analysis showed that the higher the grade of sacroiliac joints X-ray classification, the shorter the maintenance remission duration, and syndesmophyte formation might be a significant factor of relapse (OR = 8.77, P=0.006). Conclusion Short-term and full-dose ETN combined with NSAIDs is effective for ax-SpA patients who responded poorly to NSAIDs. The damage of sacroiliac joints and formation of syndesmophyte are predictors of recurrence.
ABSTRACT
Objective To assessed the expression of inducible costimulator(ICOS)on peripheral blood and joint fluid CD4,CDS,CD45RO T cells and B cells in rheumatoid arthritis(RA).Methods Expression of ICOS and ICOS/CD45RO on peripheral blood and joint fluid CD4~+CD8~+T cells and ICOS ligand(ICOSL)on CD19 B cells from RA patients and healthy volunteers were determind by three-color flow cytometry.Compar- ision with active and inactive RA,initial and relapsed RA had been done.Results Joint fluid CD4 and CD8 T cells expressing ICOS,ICOS/CD45RO were significantly increased than peripheral blood in RA patients and healthy subjects.Joint fluid B cells expressing ICOSL were significantly reduced than peripheral blood in RA patients.Meanwhile,peripheral blood B cells expressing ICOSL were significantly reduced in active RA than inactive RA patients.Conclusion Hyperexpression of ICOS and ICOS/CD45RO on joint fluid CD4 and CD8 T cells and lowexpression of ICOSL in B cells from RA patients,expecially in active RA may contribute to the local immunopathological roles and joint destructions in the pathogenesis of RA.