| Objective:By studying how various b DMARDs were used to treat ankylosing spondylitis(AS),the differences in effectiveness between currently available b DMARDs,particularly tumor necrosis factor α inhibitors(TNFi)and interleukin 17 inhibitors(IL-17i)were clarified.The goal is to establish an evidence-based foundation for identifying target populations in need of treatment in the future.Additionally,clinical practitioners may overlook AS patients with hip involvement,which can result in a poor prognosis.Through clinical observation,this study analyzed the characteristics and risk factors of AS patients with hip involvement,providing more meaningful clinical guidance for early diagnosis and treatment.Methods:AS patients who were admitted to the Department of Rheumatology and Immunology at Shanghai Changzheng Hospital between July 2020 and September 2022 were enrolled in this study.All patients met the modified New York classification criteria and provided signed informed consent.Treatment with IL-17 i,TNFi or conventional drugs was chosen by clinicians based on patient diagnosis and recommendations from authoritatively guidelines.Demographic data was collected prior to the start of treatment,including blood routine index,hepatic and renal function,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),human leukocyte antigen B27(HLA-B27),hepatitis B infection markers,T-spot test for tuberculosis,tumor markers,and other relevant information.At the baseline,all patients underwent a complete spinal X-ray examination and disease activity assessment,including the Bath Ankylosing Spondylitis Disease Activity Index(BASDAI),Bath Ankylosing Spondylitis Functional Index(BASFI),Ankylosing Spondylitis Disease Activity Score(ASDAS),fatigue(The Functional Assessment of Chronic Illness Therapy,FACIT),anxiety and depression assessment(Hospital Anxiety and Depression Scale,9-item Patient Health Questionnaire depression scale),etc.AS patients treated with b DMARDs were followed up at 12 and 24 weeks respectively,and disease data was recorded during the follow-up period and compared to baseline to complete the efficacy evaluation of different b DMARDs.Additionally,particular attention was paid to AS patients with hip involvement,and the clinical characteristics of these patients were further analyzed.To comprehensively analyze the characteristics and risk factors of AS patients with hip involvement,the Harris Hip Score,Bath Ankylosing Spondylitis Radiology Index-hip(BASRI-h),and hip magnetic resonance imaging(MRI)were used.Results:1.The study included 126 patients,and those with AS who were treated with conventional drugs had a shorter course of disease(P<0.05),older age of onset(P<0.05)and a higher proportion of male(P<0.05).Disease activity indicators such as BASDAI,BASFI,ASDAS and others were significantly lower in AS patients treated with conventional drugs than those treated with b DMARDs(P<0.05).At the same time,the mobility and imaging evaluation indexes such as thoracic expansion,Schober test and BASRI-h were better in patients treated with conventional drugs than those treated with b DMARDs(P<0.05);2.At baseline,there was no statistical difference in disease activity assessment indicators between the two groups of AS patients who treated with b DMARDs.However,at 12 and 24 weeks,all indicators showed a significant improvement compared to the baseline period(P<0.05).When comparing the two groups,no significant difference was found between the IL-17 i group and the TNFi group in the improvement of multiple disease activity indexes.AS patients treated with IL-17 i had a better improvement in the 9-item Patient Health Questionnaire depression scale(PHQ-9)score at two follow-up visits(P<0.05)compared to the TNFi group.In addition,the improvement in the Hospital Anxiety and Depression Scale(HADS)score at 24 weeks was better in the IL-17 i group than TNFi group(P<0.05),and similar results were observed in AS patients treated with b DMARDs for the first time.Furthermore,there was no difference in efficacy among different TNF-αinhibitors;3.Being female(P<0.05)was identified as an independent risk factor for AS patients who can not achieve an ASAS20 response.Conversely,a higher patients’ global VAS1 score was found to be a protective factor for AS patients who can achieve an ASAS20response;4.In AS patients with poor Harris Hip Score(less than 70)or abnormal BASRIh(BASRI-h≥2),inflammatory indicators(CRP,ESR)and related disease activity index were higher than in other AS patients(P<0.05).Multivariate logistic regression analysis revealed that a higher Health Assessment Questionnaire Disability Index(HAQ-DI)score was an independent risk factor for poor Harris Hip Score(P<0.05).A history of disease-modifying antirheumatic drugs(DMARDs)and a higher HADS-D score(P<0.05)were identified as independent risk factors for abnormality of BASRI-h.AS patients with poor Harris Hip Score also showed a higher proportion of bone hyperplasia and joint effusion on MRI(P<0.05).Conclusion:AS patients treated with b DMARDs showed significantly higher disease activity and other indicators compared to patients treated with conventional drugs.There was almost no difference between IL-17 i and TNFi in terms of improving disease activity,but IL-17 i may be more effective in improving anxiety and depression.AS patients with hip involvement had higher disease activity and may be associated with poorer health and mental status. |
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