Abstract：
Tumor necrosis factor inhibitors (TNFi) are indicated to treat ankylosing spondylitis (AS), also termed radiographic axial spondyloarthritis (axSpA). The main indication for TNFi is symptom relief, and whether they retard spinal structural damage as assessed by radiography is debated. Hips are the most common \"non-spinal\" joints involved in AS patients leading to major incapacitation. No major treatment guidelines mention measures to prevent peripheral joint damage, especially hips, in individuals with AS. We present our experience of prevention of structural damage in hips by TNFi in 4 AS patients from our practice. We conducted a literature review looking for articles describing prevention of structural damage progression in hips by TNFi. Over a 10-year period, three out of four patients were treated with TNFi and had no progression in hip damage as assessed by imaging. Only one patient that withdrew the TNFi due to infectious complications developed rapid worsening and required hip arthroplasty. Our literature review showed multiple case series with similar results suggesting that use of TNFi in patients with AS may prevent structural damage and at least postpone a hip replacement at a young age. Based on our experience, as well as from the literature review, we believe that treatment guidelines in axSpA should recommend prompt institution of TNFi following identification of hip involvement in patients to prevent a major source of disability. Whether interleukin (IL)-17 inhibitors or targeted synthetic anti-rheumatic drugs have hip sparing effects in patients with AS should also be investigated. Key Points • Hip involvement in ankylosing spondylitis is a major source of disability. • TNFi prevent hip damage in ankylosing spondylitis. • Prompt institution of TNFi should follow suspicion of hip involvement in ankylosing spondylitis.
摘要：
肿瘤坏死因子抑制剂（TNFi）用于治疗强直性脊柱炎（AS），也称为放射学轴性脊柱关节炎（axSpA）。TNFi的主要适应症是症状缓解，以及它们是否会延迟通过射线照相术评估的脊柱结构损伤仍有争议。髋关节是AS患者最常见的“非脊柱”关节，导致严重失能。没有主要治疗指南提到防止周围关节损伤的措施，尤其是臀部,在个人与AS。我们从我们的实践中介绍了通过TNFi预防4例AS患者髋关节结构损伤的经验。我们进行了文献综述，寻找描述通过TNFi预防臀部结构性损伤进展的文章。在10年的时间里,4例患者中有3例接受了TNFi治疗,影像学评估显示髋关节损伤无进展.只有一名因感染并发症而撤回TNFi的患者迅速恶化并需要进行髋关节置换术。我们的文献综述显示了多个病例系列，结果相似，表明在AS患者中使用TNFi可以防止结构损伤，至少可以推迟年轻时的髋关节置换术。根据我们的经验,以及从文献综述来看，我们认为,axSpA的治疗指南应建议在确定患者髋关节受累后立即使用TNFi,以预防主要致残.还应该研究白介素（IL）-17抑制剂或靶向合成抗风湿药在AS患者中是否具有髋关节保护作用。要点•强直性脊柱炎的髋关节受累是残疾的主要来源。•TNFi预防强直性脊柱炎的髋关节损伤。•在怀疑强直性脊柱炎的髋关节受累后，应迅速建立TNFi。
