Systematic Review Of Randomized Controlled Trials Of Glucocorticoid For Ankylosing Spondylitis

【Objective】：To evaluate the efficacy and side effect of corticosteroids in thetreatment of ankylosing spondylitis.【Methods】: We used "ankylosing spondylitis, spondyloarthropathy,glucocorticoid, prednisone, prednisolone, dexamethasone" as terms andsearched the electronic dababase PubMed (2001.01-2011.12) and Cochranelibrary (2001.012011.12), We also used these terms searchingChinese journalfull-text database (2001.01-2011.12), Chinese periodical network Publicationdatabase (2001.01-2011.12), China biological medical literature database(2001.012011online edition) and China excellent doctor master’s degreethesis full-text database (2001.01-2011.12). We selected all relevant clinicalrandomized controlled trials and quasi-randomized controlled trial s ofglucocorticoid treating AS without language limitation. Two reviewersindependently selected the trials, evaluate the methodological quality andextracted the data from the included trials.Analyzes the data In this software ofRevMan5.0,【Results】：We identified2randomized controlled trials (N=94cases). Bothapplied high dose glucocorticoid for AS patients who did not respond toNon-Steroid Anti-Inflammatory Drugs (NSAIDs)The outcomes included pain atnight, Bath ankylosing spondylitis disease activity index（BASDAI） VAS score,ASAS20(40), and others. Zhang Lixia2010trial compared methylprednisolone（250-500mg/d，3d/w）with Infliximab（0.2g/w）treating AS patients. For threeweeks No significant differences were found in BASDAI Bath Weighed meandifference (WMD) were0.19,95%CI（-0.39,0.77）, BASFI(WMD)were0.69,95%CI（0.17，1.21）、VAS score (WMD) were0.07,95%CI（-0.68,0.82）,ESR (WMD) were-2.47mm/h,95%CI（-5.03，0.09）.For ASAS 20, RR is1.01,95%CI（0.76,1.32）, ASAS40RR is0.89,95%CI（0.58-1.37）.Rumiantseva OA.2006trial compared methylprednisolone（500-1000mg/d，3d/w）with dexamethasone treating AS patients. For three months Nosignificant differences were found in BASDAI Bath Weighed mean difference(WMD) were-0.59，95%CI (-1.60,-0.42), BASFI(WMD) were-0.28，95%CI(-2.06,1.50)、VAS score(WMD) were-1.60，95%CI（-4.34,1.14），,ESR (WMD)were1.45mm/h，95%CI（0.59，2.31），.For ASAS20, RR is1.18，95%CI（0.86,1.62），ASAS40RR is1.08，95%CI（0.66-1.77）。【Conclusion】:1. High dose methylprednisolone treating NSAIDs refractory ASpatients showed benefit in alleviating pain and reducing inflammatory markers,comparable to those of Infliximab.2. High dose methylprednisolone and dexamethasone had similar effect for ASpatients.3. No severe side effects were reported form these2trials applying high doseglucocorticoid.