Song In-Ho, Hermann Kay-Geert, Haibel Hildrun, Althoff Christian E, Poddubnyy Denis, Listing Joachim, Weiß Anja, Freundlich Bruce, Lange Ekkehard, Rudwaleit Martin, Sieper Joachim
Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Rheumatology, Med. Clinic I, Rheumatology, Hindenburgdamm 30, 12203 Berlin, Germany.
Charité Universitätsmedizin Berlin, Campus Mitte, Radiology, Berlin, Germany.
Semin Arthritis Rheum. 2016 Feb;45(4):404-10. doi: 10.1016/j.semarthrit.2015.08.005. Epub 2015 Sep 4.
To assess the relationship between active inflammation and development of chronic lesions in the spine and sacroiliac (SI)-joints on MRI in early axial spondyloarthritis (SpA) during treatment with etanercept.
Here, we analyzed the 41 patients of the ESTHER trial, who were treated with etanercept over 3 continuous years and of whom MRIs were available for baseline, year 2, and year 3. MRIs were scored for active inflammation (STIR sequences) and chronic changes (T1 sequence) such as fatty lesions, erosions, and ankylosis in the SI joints and spinal vertebral units (VUs).
The mean fatty lesion scores increased between baseline and year 2 both in the spine (1.13 at baseline vs. 1.40 at year 2, p = 0.0254) and in the SI joints (4.76 at baseline vs. 5.46 at year 2, p = 0.27), but we found no further increase of the fatty lesion score between years 2 and 3. New fatty lesions at years 2 and 3 developed nearly exclusively in SI joint quadrants and VUs in which active MRI inflammation was present at baseline. Fatty lesions disappeared only in 3 SI joint quadrants and in none of VUs at years 2 and 3. Erosion and ankylosis scores remained unchanged.
Our data indicate a relationship between the presence of active MRI inflammation and the new development of fatty lesions. Furthermore, there was no increase of fatty lesions during continuous treatment of axial SpA patients with etanercept after successful suppression of active inflammation. Whether this is predictive of stopping radiographic progression needs to be further investigated.
评估在早期轴性脊柱关节炎（SpA）患者接受依那西普治疗期间，MRI上脊柱和骶髂关节（SI关节）的活动性炎症与慢性病变发展之间的关系。
在此，我们分析了ESTHER试验中的41例患者，这些患者连续3年接受依那西普治疗，且在基线、第2年和第3年均有MRI检查结果。对MRI进行评分，评估SI关节和脊柱椎体单元（VUs）的活动性炎症（短T1反转恢复序列）和慢性改变（T1序列），如脂肪病变、侵蚀和强直。
在脊柱（基线时为1.13，第2年时为1.40，p = 0.0254）和SI关节（基线时为4.76，第2年时为5.46，p = 0.27）中，平均脂肪病变评分在基线至第2年期间均有所增加，但在第2年至第3年期间，脂肪病变评分未进一步增加。在第2年和第3年出现的新脂肪病变几乎仅发生在基线时存在MRI活动性炎症的SI关节象限和VUs中。在第2年和第3年，仅3个SI关节象限的脂肪病变消失，VUs中无一例脂肪病变消失。侵蚀和强直评分保持不变。
我们的数据表明MRI活动性炎症的存在与脂肪病变的新发展之间存在关联。此外，在成功抑制活动性炎症后，对轴性SpA患者持续使用依那西普治疗期间，脂肪病变并未增加。这是否能预测影像学进展停止，有待进一步研究。
