Background Spinal mobility, as assessed by the Bath Ankylosing Spondylitis Metrology Index, BASMI, and imaging findings have been reported to correlate on the group level. Treatment with anti-TNF leads to improvement of both spinal inflammation as assessed by magnetic resonance imaging (MRI) and total BASMI scores. Objectives Using data from the golimumab (GLM) in ankylosing spondylitis (AS) study (GO-RAISE), we analysed the relationship between single components of BASMI and MRI scores of the corresponding spinal segments in anti-TNF-treated AS patients. Methods Complete MR imaging sets and spinal mobility data were available for 91 pts who participated in GO-RAISE. The MRI scores for active (ASspiMRI-a) and chronic changes (ASspiMRI-c) of the cervical and lumbar spine were compared to BASMI values for the cervical (cervical rotation (CR) and tragus-to-wall (TTW)) and the lumbar (lumbar flexion (LF) and lateral lumbar flexion (LLF)) spine using the linear definition. Spearman correlation coefficients were calculated for baseline scores and for changes in both BASMI and ASspiMRI-a and -c measurements of patients treated with GLM or placebo (PBO) after 14 weeks and after 2 years of GLM therapy. Subanalyses were performed with regard to age. Results At baseline, ASspiMRI-a scores of the cervical spine correlated with TTW (r=0.31, p=0.003) and CR (r=0.32, p=0.002) measurements, while ASspiMRI-a scores of the lumbar spine correlated with LF and LLF scores (both r=0.41, p<0.0001). In addition, ASspiMRI-c scores of the cervical spine correlated with TTW (r=0.46) and CR (r=0.45), both p<0.0001, while ASspiMRI-c scores of the lumbar spine correlated with LF (r=0.34, p=0.001) and LLF scores (r=0.41, p<0.0001). ASspiMRI-a scores correlated better in patients <40 years (TTW: r=0.31, p=0.04, LLF: r=0.42, p=0.005), while ASspiMRI-c scores correlated better in patients >40 years (TTW: r=0.35, p=0.015, LLF: r=0.48, p<0.001). In contrast, no significant correlations were found in change scores (data not shown). There was a negative correlation between MRI chronicity scores and lateral lumbar flexion at 2y: r=-0.26, p=0.037. Conclusions Our data confirm earlier reports on patients with active AS which showed that both inflammation and structural changes contribute to impairments of spinal mobility. In addition, we demonstrate significant correlations of MRI findings with detailed spinal mobility measures before anti-TNF treatment was started. Inflammatory changes had greater impact on spinal mobility in younger patients, while structural changes had more influence on spinal mobility in older patients. The correlation of the observed changes in MRI scores and spinal mobility was significant but not high. This may be due to the different mixture of active and chronic changes in individual patients. Disclosure of Interest X. Baraliakos Grant/research support: Janssen Research & Development, LLC, K.-G. Hermann Grant/research support: Janssen Research & Development, LLC, S. Xu Grant/research support: Janssen Research & Deve...
BackgroundSeveral observational studies showed a low, but still detectable progression of structural damage in the sacroiliac joints (SIJ) in patients with axial spondyloarthritis (axSpA) over 2 to 5 years. Few predictors of progressions, such as elevated C-reactive protein (CRP) and active inflammation on magnetic resonance imaging (MRI), have been identified, mostly in patients not treated with TNF inhibitors. To date, it is not clear whether these predictors also work in patients treated with anti-TNF agents and whether anti-TNF therapy is able to retard such a progression.ObjectivesTo evaluate the radiographic progression in the sacroiliac joints (SIJ) and to identify predictors of such a progression during long-term (up to six years) treatment with tumour necrosis factor (TNF) blocker etanercept in patients with early axSpA.MethodsIn the ESTHER trial1 a total of 76 patients with early (up to 5 years symptom duration) and active axSpA were randomised to be treated with either etanercept or sulfasalazine for one year. Between year 1 and year 6, all patients who continued in the study were treated with etanercept. X-rays of SIJ were collected at baseline and every 2 years thereafter. Two trained readers, who were blinded for all clinical data, scored independently the SIJ x-rays in a concealed and randomly selected order, according to the grading system of the modified New York (mNY) criteria (grade 0 to 4). Patients with bilateral sacroiliitis of grade ≥2 or unilateral of grade ≥3 were classified as radiographic axSpA (r-axSpA), and as non-radiographic axSpA (nr-axSpA) otherwise. The sacroiliitis sum score (0–8) was calculated as a sum of means of both readers for the left and right SIJ. Active and chronic inflammatory changes on MRI of SIJ were assessed at baseline, year 2 and year 4 according to the Berlin MRI scoring system. A longitudinal mixed model analysis was performed to identify predictors of the radiographic sacroiliitis progression.Abstract OP0025 – Table 1. Longitudinal mixed model analysis of the association between structural damage in the sacroiliac joints (sacroiliitis sum score) and disease-related parameters in patients with early axSpA treated with etanercept for up to 6 years.ResultsTotally, 55 patients with axSpA contributing with 159 SIJ radiographs were included in the analysis. At baseline, 19 patients were classified as r-axSpA and 36 as nr-axSpA based on the independent SIJ reading. Radiographic progression from nr- to r-axSpA was observed in 5 (18%) patients between baseline and year 2. Progression decelerated to 4.1% between year 2 and 4, and no further progression was observed up to year 6. The mean ±SD change of sacroiliitis sum score was 0.13±0.73,–0.26±0.76 and −0.09±0.67, in the time intervals baseline-year 2, year 2 year 4, and year 4 year 6, respectively. In the longitudinal mixed model analysis, elevated CRP (model 2) and osteitis on MRI (model 1) were independently and significantly associated with a higher sacroiliitis sum score (table 1).ConclusionsLong-term therapy with ...
Background Ustekinumab – a fully human monoclonal antibody against interleukins 12 and 23 – has been shown to be effective in reduction of symptoms of active ankylosing spondylitis (AS) in a proof-of-concept study (TOPAS) [1]. Objectives The purpose of the current work was to investigate the impact of ustekinumab on active inflammation and post-inflammatory structural changes in the sacroiliac joints (SIJ) and in the spine as detected by magnetic resonance imaging in the TOPAS study. Methods In the TOPAS study, ustekinumab in a dose of 90 mg was administered subcutaneously at baseline, week 4 and week 16 in 20 patients with active AS. Eligible patients were required to have a diagnosis of AS according to the modified New York criteria and an active disease defined as a BASDAI score of ≥4 despite previous NSAIDs treatment. MRI of the SIJ and of the spine (STIR and T1-weighted sequences) was performed at baseline and at week 24. Images were scored according to the Berlin scoring system for active inflammation and for chronic changes [2], including a detailed fatty degeneration score for SIJ, independently by two trained readers in a concealed and randomly selected order, blinded for all clinical data. Results Complete MRI sets (baseline and follow-up) were available in 17 patients (13 ASAS40 responders and 4 non-responders; in 3 ASAS40 non-responders no follow-up MRIs were available). There was a significant reduction of active inflammation on MRI at week 24 as compared to baseline both in the SIJ (osteitis change score -2.2±3.8 corresponding to 41% reduction) and in the spine (osteitis change score -1.2±2.3 corresponding to 31% reduction) – table. Reduction of active inflammation after 24 weeks was more prominent and statistically significant in patients with clinical response (ASAS40): osteitis change score in the SIJ was -3.1±3.8 in responders as compared to +0.6±1.3 in non-responders, p=0.015; similarly, osteitis change score in the spine was -1.9±1.9 in responders as compared to +1.0±2.4 in non-responders, p=0.023. Notably, clinical response (ASAS40) to ustekinumab was associated with higher level of inflammation at baseline in the SIJ (osteitis score 6.7±4.9 in responders vs. 2.0±1.7 in non-responders, p=0.030), and in the spine (4.9±3.6 in responders vs. 3.6±4.1 in non-responders, p=0.2). There were no substantial changes in the scores for post-inflammatory lesions including fatty lesions in the entire group – table. However, the SIJ fatty lesion score increased significantly in patients with improvement of SIJ osteitis score by at least one point at week 24 (n=11): +0.8±1.1 vs.-0.4±0.8 in patients without osteitis improvements, p=0.022. Conclusions Ustekinumab effectively reduced active inflammation in the axial skeleton as detected by MRI in patients with AS after 24 weeks of treatment. There was a clear correlation between clinical and MRI responses. Higher level of active inflammation at baseline was associated with good clinical response. References Poddubnyy D, et al. Ann Rheum Dis 2014...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.