RESUMO
Objective To investigate the effects of HLA-B27 in disease activity and the clinical features of axial spondyloarthritis(SpA). Methods Clinical data of 112 patients with axial SpA was collected and studied prospectively. Clinical manifestations and laboratory examination results of 82 HLA-B27 positive and 30 HLA-B27 negative patients with axial SpA were analyzed. Data source was from Chinese Rheumatism Data Center. Results (1)The average age of onset of HLA-B27 negative patients was significantly later than that of the positive patients , and there was no significant difference in the course of disease and the proportion of male and female patients. (2)The ratio of severe lesion of hip ,peripheral arthritis ,attachment inflammation and systemic symptoms of HLA-B27 negative group were significantly lower than those of HLA-B27 positive group. Familial aggregation phenomenon,uveitis and spine radiology changes in two groups had no significant difference.(3)The changes of disease activity index including erythrocyte sedimentation rate and C-reactive protein increased in HLA-B 27 negative group was significantly lower than those in HLA-B27 positive group. Conclusion There is strong correlation between axial SpA and HLA-B27. The average age of onset of HLA-B27 negative patients was significantly later than that of the positive patients. HLA-B27 negative patients manifested severe symptoms and worse prognosis.
RESUMO
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.