Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept

Abstract

Objective. To investigate the effect of etanercept therapy on radiographic progression in patients with ankylosing spondylitis (AS).Methods Conclusion. Unlike other inflammatory rheumatic diseases such as rheumatoid arthritis and psoriatic arthritis, structural progression in AS seems to be independent of TNF, despite the fact that TNF is responsible for the signs and symptoms due to inflammation in this disease.Ankylosing spondylitis (AS) belongs to a family of rheumatic diseases known as spondylarthritides that characteristically cause spinal joint inflammation and bony fusion of the spine. AS is the prototype of the spondylarthritides and is typified by ankylosis of the axial skeleton. Radiographic damage known to result from AS primarily includes fusion of entheses of the sacroiliac joints and of the posterior articulations and ligaments of the spine. These fusions can lead to impaired spinal mobility and in turn decreased ability to perform daily activities and severely reduced healthrelated quality of life (1).Tumor necrosis factor ␣ (TNF␣) has been shown to play an important role in the inflammatory response observed in AS. It has been found at increased levels in the serum and synovium of patients with AS (2,3), and treatment with TNF␣-blocking agents (etanercept, adalimumab, and infliximab) has been shown to safely and effectively reduce the signs and symptoms of AS (4-6) and significantly improve health-related quality of life (1). In addition, these agents have been shown to ClinicalTrials.gov identifier: NCT00356356.

Critical appraisal of assessment of structural damage in ankylosing spondylitis: Implications for treatment outcomes

“…However, because it is not feasible to conduct a placebo-controlled study over 2 years, patients from the long-term observational cohort of the Outcome Assessments in Ankylosing Spondylitis International Study (OASIS), which was started in the 1990s, were used as the control group. The results of both studies, reported thus far in abstract form, have indicated that there was no significant difference in the mean score for radiographic progression between the groups treated with the TNF blockers etanercept (11) or infliximab (12) and the control group. Interestingly, in both studies, there was a small but nonsignificant tendency for less radiographic progression in the patients treated with TNF blockers when their scores were compared with only those in the subgroup of OASIS patients who met the eligibility criteria for inclusion in the TNF blocker trials.…”

“…Therefore, in 2 trials of TNF blockers, the baseline score was compared with the score after 2 years of treatment (11,12). However, because it is not feasible to conduct a placebo-controlled study over 2 years, patients from the long-term observational cohort of the Outcome Assessments in Ankylosing Spondylitis International Study (OASIS), which was started in the 1990s, were used as the control group.…”

Focal fat lesions at vertebral corners on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis

“…An alternative hypothesis was then proposed whereby pathogenetic factors such as altered gene expression, biomechanical factors, and bacteria trigger the concomitant expression of inflammation and new bone formation, which then proceed along essentially autonomous pathways (2). This hypothesis has been advanced to explain the apparent lack of benefit of anti-TNF␣ agents on the radiographic progression of AS (3)(4)(5).…”

Anti-TNF agents for the treatment of active non-radiographic axial spondyloarthritis

“…The goal of treatment of axial SpA is to obtain the suppression of symptoms but also the prevention of structural bone damage and of ankylosis. The studies on anti-TNF agents in longstanding axial disease have demonstrated that the structural damaged cannot be prevented and that it is independent from the presence of absence of inflammatory activity (13)(14)(15). A great effort should be done to increase the referral of every axial SpA patient to the rheumatologist.…”