Infliximab Therapy for Inflammatory Discitis in Ankylosing Spondylitis

Joshi, Nilay; Nautiyal, Amit; Walton, Tom

doi:10.1097/rhu.0b013e31824a4aab

Cited by 4 publications

(8 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1][2]5,[7][8]10,12,14,19,25 Currently, with the routine use of MRI and CT, fractures or nonfusion of the facet joints can be detected at an early stage, which can facilitate the accurate diagnosis and the assessment of prognostic related to the outcomes of AL. [16][17]19,24 Chang et al 25 in AS in relation to JOA recovery rate. 11,23,26 The role of laboratory tests in patients with AL is also controversial.…”

Section: Discussionmentioning

confidence: 99%

“…For patients treated with surgery, the average JOA score was 9.1 ± 1.5 (range 5.5-14) on admission and 13.2 ± 2.2 (range 7. [5][6][7][8][9][10][11][12][13][14][15][16][17] at the final follow-up. In the conservative treatment group, the average JOA score was 11.5 ± 2.9 (range 6.5-14) on admission and 12.1 ± 0.8 (range 8.5-16) at the final follow-up.…”

Section: Joa Scorementioning

confidence: 99%

“…1,3,[5][6][7][8]13 Because most clinical studies on AL have been based on case reports and retrospective studies of small samples, large investigations of the medium-to long-term outcomes of this lesion are lacking. 5,7,16 In this study, we retrospectively analyzed 48 patients with AL at our center to determine the medium-to long-term outcomes and prognostic factors related to this lesion. Furthermore, we compared the medium-to long-term therapeutic effects of the surgical and conservative treatment of AL and discussed the clinical management of AL.…”

Section: Introductionmentioning

confidence: 99%

“…Reported prognostic factors include age, gender, symptom duration, erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP), human leukocyte antigen (HLA)‐B27 positivity, lesion location, steroid treatment, osteoporosis, pseudarthrosis, neurological impairment, Cobb's angle of kyphosis, bone fusion and treatment modality 1,3,5‐8,13 . Because most clinical studies on AL have been based on case reports and retrospective studies of small samples, large investigations of the medium‐ to long‐term outcomes of this lesion are lacking 5,7,16 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Effects of Andersson lesion treatment in ankylosing spondylitis: A medical record review study focused on medium‐ to long‐term outcomes

Yan

Ping

et al. 2020

Int J of Rheum Dis

View full text Add to dashboard Cite

The present study aimed to evaluate the clinical efficacy of Andersson lesion (AL) treatments and prognostic factors using medium-to long-term follow-up data and discuss the clinical characteristics and treatment of AL. Forty-eight consecutive AL cases at our center from June 2011 to March 2018 were retrospectively analyzed, including 13 cases treated conservatively and 35 treated surgically. Epidemiological characteristics, treatment modalities, clinical features and outcomes, and prognostic factors of the Japanese Orthopaedic Association (JOA) recovery rate were reviewed. Neurological functional recovery was evaluated by American Spinal Injury Association (ASIA) classification. Clinical efficacy was evaluated by JOA score, visual analog scale (VAS) score, and Cobb's angle. The mean overall follow-up duration was 44.5±18.5 months (range, 27-85 months). There were 36 male and 12 female patients, with a mean age of 49.4±13.1 years (range, 26-72 years). The most common lesion location was the thoracolumbar region, i.e., T10-L2 (n=33; 68.8%), followed by the thoracic (n=10) and lumbar (n=5) regions. Patients treated surgically showed significantly better JOA scores, VAS scores and Cobb's angles at the final follow-up than did patients treated conservatively (P<.05). Univariate and binary logistic regression analyses identified two prognostic factors of the JOA score recovery rate: treatment modality (OR=0.157; 95%CI, 0.028-0.89; P=.036) and bone fusion (OR=9.965; 95%CI, 2.052-48.387; P=.004). Conservative treatment and bone nonunion predict worse JOA score recovery. Surgery remains the optimal treatment for AL in ankylosing spondylitis patients, with better clinical efficacy demonstrated by medium-to long-term follow-up data.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Joa Scorementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of Andersson lesion treatment in ankylosing spondylitis: A medical record review study focused on medium‐ to long‐term outcomes

Yan

Ping

et al. 2020

Int J of Rheum Dis

View full text Add to dashboard Cite

show abstract

“…The treatment of these conditions is unclear as there are no randomized controlled trials or observational studies dedicated to addressing this question. One case report did show clinical and radiological improvement in inflammatory discitis with the use of anti-tumor necrosis factor (TNF) therapy [ 2 ]. Another report demonstrated effective treatment of cauda equina syndrome in ankylosing spondylitis with adalimumab [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Thoracic Discitis in Ankylosing Spondylitis

Maloney

Srinivasan

Shaver

2018

Cureus

View full text Add to dashboard Cite

Chronic ankylosing spondylitis can lead to several rare long-term complications including cauda equina syndrome and inflammatory discitis especially without treatment. These complications are uncommon, but there is evidence that they can be treated with anti-tumor necrosis factor (TNF) inhibitors.We present a case of a 52-year-old male with a 30-year history of undiagnosed ankylosing spondylitis with cauda equina syndrome on initial outpatient presentation with a negative lumbosacral magnetic resonance imaging (MRI). He was admitted later that month and was found to have thoracic discitis from MRI requiring emergent decompressive laminectomy. The neurosurgeon collected a culture of the surgical site which showed rare Gram-positive cocci on Gram stain. Infectious disease was consulted, and he was started on empiric vancomycin. The culture from the surgical site did not grow any organisms. Interventional radiology (IR) aspirated the T7-T8 disk area one week later. The initial Gram stain showed rare Gram-negative rods this time, and cefepime was added to the patient's antibiotic regimen. The culture from the disk aspiration again grew no organisms. Rheumatology was then consulted and hypothesized that the patient's discitis could be secondary to inflammation from long-standing ankylosing spondylitis. The hospitalist, infectious disease specialist, and rheumatologist reviewed the case and recommended a six-week course of vancomycin and cefepime despite the negative cultures as an infectious etiology could not be excluded. He did show some clinical improvement after surgery and was started on adalimumab following completion of empiric antibiotics.This case highlights the difficulty in distinguishing between an infectious and inflammatory etiology for discitis in the setting of long-standing ankylosing spondylitis. The initiation of biological therapy without completely excluding the possibility of infection could lead to devastating consequences. It will likely be necessary to empirically treat for infection with these cases for the foreseeable future until there are more definitive tests to diagnose or exclude infectious discitis.

show abstract

Predictive Factors of Clinical Response of Infliximab Therapy in Active Nonradiographic Axial Spondyloarthritis Patients

Liao

Huang

Ai³

et al. 2015

BioMed Research International

View full text Add to dashboard Cite

Objectives. To evaluate the efficiency and the predictive factors of clinical response of infliximab in active nonradiographic axial spondyloarthritis patients. Methods. Active nonradiographic patients fulfilling ESSG criteria for SpA but not fulfilling modified New York criteria were included. All patients received infliximab treatment for 24 weeks. The primary endpoint was ASAS20 response at weeks 12 and 24. The abilities of baseline parameters and response at week 2 to predict ASAS20 response at weeks 12 and 24 were assessed using ROC curve and logistic regression analysis, respectively. Results. Of 70 axial SpA patients included, the proportions of patients achieving an ASAS20 response at weeks 2, 6, 12, and 24 were 85.7%, 88.6%, 87.1%, and 84.3%, respectively. Baseline MRI sacroiliitis score (AUC = 0.791; P = 0.005), CRP (AUC = 0.75; P = 0.017), and ASDAS (AUC = 0.778, P = 0.007) significantly predicted ASAS20 response at week 12. However, only ASDAS (AUC = 0.696, P = 0.040) significantly predicted ASAS20 response at week 24. Achievement of ASAS20 response after the first infliximab infusion was a significant predictor of subsequent ASAS20 response at weeks 12 and 24 (wald χ 2 = 6.87, P = 0.009, and wald χ 2 = 5.171, P = 0.023). Conclusions. Infliximab shows efficiency in active nonradiographic axial spondyloarthritis patients. ASDAS score and first-dose response could help predicting clinical efficacy of infliximab therapy in these patients.

show abstract

Infliximab Therapy for Inflammatory Discitis in Ankylosing Spondylitis

Cited by 4 publications

References 4 publications

Effects of Andersson lesion treatment in ankylosing spondylitis: A medical record review study focused on medium‐ to long‐term outcomes

Effects of Andersson lesion treatment in ankylosing spondylitis: A medical record review study focused on medium‐ to long‐term outcomes

Thoracic Discitis in Ankylosing Spondylitis

Predictive Factors of Clinical Response of Infliximab Therapy in Active Nonradiographic Axial Spondyloarthritis Patients

Contact Info

Product

Resources

About