THU0269 Spinal and sacroiliac inflammation as detected by magnetic resonance imaging in patients with ankylosing spondylitis, before and after 12 weeks therapy with non-steroidal anti-inflammatory drugs

Abstract

Objectives To assess the inflammatory lesions of the spine and the sacroiliac joints (SIJ) as detected by magnetic resonance imaging (MRI) in patients (pts) with ankylosing spondylitis (AS) during 12 weeks treatment NSAIDs for the first time on daily basis. Methods Thirty consecutive patients (pts) meeting the modified NY criteria AS were studied. MRI (T2 STIR and T1 MRI sequence, General Electrics, 0.35T, matrix 288×192) of the most painful segment of spine and SIJ were performed at baseline (TP0) and after 12 weeks treatment NSAID’s (TP1). For assessing active spinal lesions we used the scoring system modified ASspiMRI-a, and for SIJ - Leeds scoring system. MR images were evaluated independently by 2 readers and one of them was blinded to the treatment allocation and time sequence of the images. Results Median pts age was 32.5±6.8 yrs, 24 (80%) male, median disease duration was 8.8±5.4 yrs; 29 (96.6%) pts were HLA-B27 positive. Lumbal spine MRI were performed in 19 pts, thoracic spine - in 11 pts. ASAS-NSAID Index 12 weeks satisfied 100 (indometacin 150mg/day (n=6), diclofenac 100-150mg/day (n=14), nimesulide 200mg/day (n=6), meloxicam 15mg/day (n=3), etoricoxib 120 mg/day (n=1)). BASDAI ≥4.0 at TP0 had 16 pts (53.3%), at TP1 – 10 pts (33.3%). Mean the most painful segment of spine level at TP0 was 4.8±2.3, at TP1 - 2.6±2.3, p =0.00001. Spinal inflammation regression was seen after 12 weeks but was not reliable (mean (SD) 2.80±2.55 at TP0 vs 2.26±2.16 at TP1; p =0.20). Regression of active SIJ lesions also was not reliable (mean (SD) 2.80±2.65 at TP0 vs 2.23±2.03 at TP1; p =0.083). MRI spinal lesions disappeared in 2 pts (6.6%) after 12 weeks NSAIDs therapy but in one pt its appeared de novo. MRI SIJ lesions disappeared in 5 pts (16.6%) after 12 weeks NSAIDs therapy but in one pt its appeared de novo. Conclusions NSAIDs decreased the level of pain in the spine. NSAIDs for 12 weeks was not effective enough for reducing imaging evidence of disease activity in patients with MRI determined inflammatory lesions. Disclosure of Interest None Declared