The Research On The Diagnosis And Treatment Of Ankylosing Spondylitis

Background:Ankylosing Spondylitis, AS is a chronic, multi-system inflammatory disease.It mainly affects the sacroiliac joints, axial skeleton, as well as theperipheral joints, and extra-articular organs, such as skin, eyes and cardiovascular system. Recently, Shanghai CP Guojian Pharmaceutical Co., Ltd. has developed the water injection type packaging with a disposable prefilled syringeon the basis of Etanercept powder type.And the specifications, clinical indications, usage, dosage as well as route of administration are same as powder type. At present, therapeutic efficacy of water injection type has not yet been reported. Nuclear magnetic resonance MRIis regarded as an important tool for the evaluation of rheumatic diseases. Currently, MRI evaluation of ankylosing spondylitis, sacroiliac joints and spine MRI is mainly based onscoring method of Canadian International Research Group (Spondyloarthritis Research Consortium of Canada, SPARCC) as well as The FAt Spondyloarthritis Spine Score, FASSS. However, for the application of the above method of evaluating Etanercept (water type) in the treatment of active ankylosing spondylitis based MRI has not been reported domestically. Also septic sacroiliitis is a rare disease, often appear hip area or lumbosacral pain, radiographic lesions and arthritis of the spine is very easily lead to the clinical misdiagnosis. This study was designed to assess efficacy of preliminary water injection type Etanercept in active ankylosing spondylitis, explore the application methods before and after etanercept treatment of ankylosing spondylitis sacroiliac, and evaluate spine MRI changes base on retrospective analyisis of septic sacroiliitis and radiological data in our hospital, and provide knowledge to clinicians in order to avoid misdiagnosis.Methods:No.l In order to test the drug Eetanercept, we designed a study according to the different modes of administration, randomized, double-blind, parallel-group clinical trial. Enrolled 70 cases of active ankylosing spondylitisinclusion and exclusion criteria.According to the different modes of administration, patients were randomly assigned to the experimental group and the experimental group A, B. The therapeutic efficacy was analyzed after 0,2,4,8,12,16,20,24 week of drug administration, and the whole spine MRI scans, (1) the efficacy of indicators include Bath Ankylosing Spondylitis Disease Activity Index BASDAI; Bath Ankylosing Spondylitis Functional Index Questionnaire (Bath Ankylosing Spondylitis Functional Index, BASFI) score; Bath Ankylosing spondylitis metrology index, BASMI; ankylosing spondylitis disease activity score, ASDAS; (2) serum markers include plasma sedimentation rate, ESR, C-reactive protein, CRP; (3) using SPARCC and FASSS scoring methods to evaluated MRI images in a blinded methods. No.2 Retrospective analysis of. 1241 cases in June 2005-September 2014, which mainlycomplaint was hip pain in the lumbosacral region. After analysinglaboratory tests, blood cultures, imaging diagnosis and treatment data.,21 cases of infectious sacroiliitis were discovered. This study was to summarize the clinical and radiological features of septic sacroiliitis, and provide methods to avoid confusion caused by arthritis of the spine.Results:In the first part of our study, fter 24 weeks of treatment, all the30 patients achieve ASAS 20, and 20 patients reached ASAS 40 (66.7%).After the first two weeks treatment, except BASMI, PLT, ESR, CRP, BASDAI, BASFI, ASDAS and other indicators are significant decline (P<0.05).Compared with 0 weeks,8 weeks of treatment showed higher BASFI (P<0.05).Before the treatment,24 of 30 cases (80%) was affected eith bone marrow edema, however, after treatment,bone marrow edema in 22 patients wasrecovered with varying degrees, even disappeared. But two cases of bone marrow water showed aggravation, one showed bone marrow edema after treatment. The scoresof spinal marrow edemawas significantly decreasedoverall after treatment. We recorded total of 690 vertebral bone. Before treatment, a total of 158 vertebral bone were marrow edema (22.9%). After treatment, 137 cases showed improved or disappeared, and only 28 patients were reported increased erosion fat, which, however showed no statistical significance.In the second part of our study,21 patients are enrolled because of gluteal region or lumbosacral pain, including 9 males and 12 females with mean age of 28.2 years old and mean duration of 261 days. In 21 patient,10 patients were diagnosed as ISI 10,3 were BSI and 8 were TSI. Most of the patients showed significant higher ESR and CRP level, but only one case of ISI patients is positive for HLA-B27. Pathological examination showed acute or chronic inflammatory cells and neutrophils infiltration. Infiltration of lymphocytes and plasma cells were common in BSI patients, while necrosis associated with granuloma formation are often seen inTSI patients. Radiographic examination showed 18 patient were unilateral involvement,3 patients were bilateral involvement. In 12 routine CT examinations of the sacroiliac joint, one were reported with fuzzy articular surface, five were reported bone erosion, three showed cartilage sclerosis,one was discovered osteophytes,and one case of joint fusion. In MRI images of17 sacroiliac joint patients,6 cases were mild abnormalities,11 cases showed markedly abnormal. In 2 routine PET-CT examination, both showed the lesion of the sacrum and metabolism active ilium uptake. After rational use of antibiotic treatment, the conditions of 21 patients were significantly improved.Conclusion:No.l Etanercept water injection type can rapidly improve with active ankylosing spondylitis. The PLT, ESR, CRP, BASDAI, BASFI, ASDAS and other indicators were significantly improved.The disease activity and motor function in patients were also improved.In this study group, once a week and twice a week of 50mg showed no significant difference in terms of efficacy.Etanercept significantly improved the sacroiliac and spinal vertebral bone marrow edema, reduce inflammation in the acute phase. This study suggests that in the clinical activity of ankylosing spondylitis sacroiliac and spinal vertebral bone marrow edema, the application Etanercept treatment will lead to better prognosis; No.2 Hip area and lumbosacral pain associated with radiographic sacroiliac joint abnormalities are not specific manifestation to the spine arthritis. These can also be seen in septic sacroiliitis, metabolic bone disease and other diseases. Radiographic change of infectious sacroiliac arthritis may be found in short term, and most of which only showed unilateral lesions.To the cases of similar clinical signs and radiographic unilateral, accompanied by surrounding muscle tissue involvement, the diagnosis should base on clinical symptoms, serology, ESR, C-reactive protein, even local pathological examination, if necessary and administrateantibiotics as soon as possible in order to improve the prognosis.