Treat-to-Target Strategy In Treating Ankylosing Spondylitis

Objectives:Abnormal inflammation caused by ankylosing spondylitis(AS)results in pain,joints swollen and even irreversible bone destruction,leading to disability.Tumor Necrosis Factor Inhibitor(TNFi)can effectively control the inflammatory reaction.But long-term usage of TNFi may be unfordable for patients in developing countries.Risks of TNFi related adverse effects also need more consideration.According to the latest treat-to-target strategy,we proposed a sequential medication treatment using TNFi and conventional synthesis Disease-Modifying Anti-Rheumatic Drugs(csDMARDs).Effect on clinical data,disease activity,imaging evaluation,joint function and quality of life will be evaluated in this study.Methods:A 48-week,prospective,single-arm,open-label clinical trial was conducted in patients fulfilled with modified New York 1984 criteria for AS.Patients in active phase were recruited and treated with Etanercept(ETN)or csDMARDs due to their disease activity.C-reactive protein related AS disease activity score(ASDASCRP)based disease activity were re-evaluated every 4 weeks.If it turned to high,full-dose ETN would be used for next 4 week;if it turned to medium,2-week full-dose ETN along with 2-week csDMARDs would be subscribed;if it turned to low,csDMARDs alone would be used for next 4 weeks.Treatment regime adjusted according to the disease status assessed at the end of last regime,and then repeated to assure continuous maintenance of disease activity and functions of bone and joints.At the follow-up points of 12,24 and 24 week,the clinical response was assessed by Patient Global Assessment(PaGA),Bath Ankylosing Spondylitis Disease Activity Index(BASDAI)and ASDASCRP.Bath Ankylosing Spondylitis Function Index(BASFI)was used to assess axial and peripheral joints functions.Hip joint structure evaluation was based on radiology examination with measurement of minimum joint space width(mJSW)and scored by Bath Ankylosing Spondylitis Radiology Index(BASRI).Spondyloarthritis Research Consortium of Canada Score(SPARCC)and its Sacroiliac Joint Structural Score(SPARCC SSS)were used in imaging evaluation of disease activity.Besides,a quality-of-life scale,the Scales of the Quality Of Life for Ankylosing Spondylitis(SQOL-AS)was also involved in scoring the change of participants’ basic life quality before and after treatment.Results:110 patients fulfilled inclusion and exclusion criteria were enrolled and followed up for 48 weeks.Age,sex and positive rate of HLA-B27 were similar with previous researches.At the last follow-up point,97.27%and 91.81%of participants met the criteria of ASAS 20 and ASAS 40.Acute phase reactants,BASDAI,ASDASCRP,PaGA,SQOL-AS along with SPARCC and SPARCC SSS showed significant improvement at the point of 12 weeks,24 weeks and 48 weeks.In the subgroup of hip-involved participants,BASRI and mJSW did not show any remarkable change compared to baseline.Despite the lost cases of mild adverse events,pregnancy and other personal causes,none of the patients enrolled underwent total hip arthroplasty caused by limited hip function or further damage of hip joint structure.Also,there were no severe adverse events reported during trial.Conclusions:Treat-to-target strategy in AS can individualized sustain disease activity effectively and safety,with the effect of protecting bone and joint from further destruction.Continues improvements can also be seen in body function and quality of life.This precise therapeutic strategy would be an as practical and safe,but more economical alternative scheme for low-income AS patients.