Özet
Amaç
Bu çalışmanın amacı, ileri spinal ankiloz veya bambu omurgası olan aksiyel spondiloartrit (axSpA) hastalarında klinik özellikleri, biyolojik hastalık modifiye edici antiromatizmal ilaçlara (bDMARD) tedavi yanıtını ve ilaç devamlılığını, sindesmofiti olmayan hastalarla karşılaştırarak değerlendirmektir.
Yöntem
Hacettepe Üniversitesi Romatoloji Biyolojik Kayıt Sistemi’nde yer alan ve servikal ile lomber radyografileri mevcut olan hastalar üç gruba ayrıldı: ileri spinal ankiloz, bambu omurga ve en az 10 yıllık hastalık süresi olup sindesmofiti olmayan kontrol grubu. Başlangıç özellikleri, tedavi yanıtları [Bath Ankilozan Spondilit Hastalık Aktivite İndeksi 50’nin (BASHAİ50) ve Uluslararası Spinal Ankiloz Çalışma Grubu parsiyel remisyon (ASAS-PR)] ve ilk bDMARD tedavisinin devamlılığı değerlendirildi.
Bulgular
Toplam 770 hastanın 99’unda ileri spinal ankiloz, 78’inde bambu omurga saptandı ve 92 hasta kontrol grubunu oluşturdu. İleri yapısal hasarı olan hastalar daha ileri yaşta, daha sıklıkla erkek cinsiyette olup daha yüksek vücut kitle indeksi, sigara maruziyeti ve kalça tutulumu oranına sahipti. Başlangıç hastalık aktivitesi gruplar arasında benzerdi. İzlem sürecinde BASHAİ50 ve ASAS-PR yanıtları ileri spinal ankiloz, bambu omurga ve kontrol grupları arasında benzer bulundu. İlk bDMARD tedavisinin medyan devam süresi gruplar arasında anlamlı farklılık göstermedi (log-rank p=0,86). Bir yıllık ilaç devam oranları sırasıyla %75 (sindesmofit yok), %84 (ileri spinal ankiloz) ve %78 (bambu omurga) idi. Beş yılda bu oranlar sırasıyla %67, %64 ve %60; 10 yılda ise %50, %41 ve %43 olarak bulundu. Medyan ilaç sağkalımı gruplar arasında 104-126 ay arasında değişmekteydi.
Sonuç
İleri spinal ankiloz veya bambu omurga varlığı olan hastalar bDMARD tedavisi ile anlamlı klinik iyileşme sağlamakta ve sindesmofiti olmayan axSpA hastalarına benzer uzun dönem ilaç devamlılığı göstermektedir. Bu bulgular, bu hasta grubunda bDMARD tedavisinin başlanmasını ve sürdürülmesini desteklemektedir.
Anahtar Kelimeler:
Ankilozan spondilit, aksiyel spondiloartrit, ileri spinal ankiloz, bambu omurga, bDMARD’ler, tedavi yanıtı, ilaç devamlılığı
Kaynaklar
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