强直性脊柱炎(AS)是一种以骶髂关节和脊柱中轴关节病为主要病变的慢性进行性炎症性疾病.骨外组织异常钙化、骨赘形成是AS发展的根源,异位骨形成、骨量减少、骨质疏松目前被认为是AS的共同特征,其中关键的异位骨形成机制尚未明确.细胞核因子KB受体活化因子(RANK)/细胞核因子KB受体活化因子配体(RANKL)/骨保护素(OPG)通路、骨形态发生蛋白(BMPs)介导通路、Wnt信号通路及白细胞介素(IL)-23/IL-17轴是目前研究较多的影响AS骨代谢的通路,也有少数文献报道机械载荷(ML)介导信号通路影响AS骨形成.应用骨代谢标志物,包括骨形成标志物和骨吸收标志物在AS患者异常改变,以及双能X线(DXA),定量计算机断层扫描法(QCT)、MRI、骨小梁评分(TBS)等影像学检查可协助了解AS骨代谢情况,为目前有效的治疗方法提供随访的量化指标.该文从AS骨代谢通路、AS骨代谢标志物、AS骨代谢在影像学中表现等方面对AS骨代谢的研究进展进行综述.
Aim Inflammatory joint diseases (IJDs) are chronic arthritis, but frequently present with co-morbidities of other organs and systems, which is known as extra-articular manifestations (EAMs). It is still unclear which clinical characteristics or bio-markers can predict the development of EAMs. The aim of this study was to estimate the proportion of EAMs in southern Chinese patients with IJDs and to explore the risk factors. Methods This was a retrospective cohort study of a total 1135 IJDs patients, including 788 rheumatoid arthritis (RA) patients, 307 ankylosing spondylitis (AS) patients and 40 psoriatic arthritis (PsA) patients. Demographic data, disease characteristics, laboratory blood tests, medical imaging, and the presence of EAMs were recorded. Results We found 459 (40.44%) patients presented with EAMs: 30.84% had cardiovascular involvement, 7.67% had pulmonary involvement, 5.29% had osteoporosis/low bone mineral density, 2.29% had ocular, 0.79% had gastrointestinal and 0.26% had renal involvements. Multivariate logistic regression showed older age (odds ratio [OR] 1.06, P < .001) and higher anti-cyclic citrullinated peptide antibody (anti-CCP) levels (OR 1.003, P = .019) were independent risks of EAMs in RA patients. In the AS group, older age (OR 1.07, P < .001) and higher disease activity (OR 3.24-7.42, both P < .05), were independent risks of EAMs. In the PsA group, longer disease duration (OR 1.01, P = .036) and higher disease activity (OR 1.15, P = .004) were univariate associated factors. Conclusion These results suggested the high prevalence of EAMs, and it is important to regularly screen for EAMs, as they influence treatment decisions and impact on patients' quality of life.
炎症性关节病是一组以慢性关节炎为特征的疾病,主要包括类风湿关节炎、强直性脊柱炎和银屑病关节炎.本篇综述回顾了近年来炎症关节病合并心血管损害的相关文献,发现炎症关节病患者合并心血管疾病的风险较普通人群升高,可能与高度炎症反应和长病程有关;心血管损害表现形式多样,可累及血管、心脏瓣膜、心包和心脏电传导系统,且临床症状隐匿,显著增加了患者的死亡风险.这提示我们应提高对炎性关节病合并心血管损害的重视,对炎症关节病患者进行心血管疾病筛查,积极早期诊断及治疗,以期改善患者的预后.
