Charité Universitätsmedizin Berlin, Berlin, Germany.
German Rheumatism Research Centre, Berlin, Germany.
Arthritis Rheumatol. 2019 May;71(5):722-728. doi: 10.1002/art.40786. Epub 2019 Mar 7.
To evaluate radiographic progression in the sacroiliac (SI) joints and to identify its predictors during long-term treatment (up to 6 years) with the tumor necrosis factor (TNF) inhibitor etanercept in patients with early axial spondyloarthritis (SpA).
Patients with early axial SpA who were treated with etanercept for up to 6 years in the Etanercept versus Sulfasalazine in Early Axial Spondyloarthritis (ESTHER) trial were selected based on the availability of radiographs of the SI joints. Two readers who were blinded with regard to clinical data scored the radiographs according to the modified New York criteria (range 0-4 per SI joint). A sacroiliitis sum score (total range 0-8) was calculated as the mean of the scores of the 2 readers. Active and chronic inflammatory changes in the SI joints on magnetic resonance imaging (MRI) performed at baseline, year 2, and year 4 were assessed according to the Berlin MRI scoring system.
Of the 76 patients originally included in the study, 42 had radiographs of the SI joints available at baseline and at least 1 follow-up time point (year 2, 4, or 6). The mean ± SD change in the sacroiliitis sum score was 0.13 ± 0.73, -0.27 ± 0.76, and -0.09 ± 0.68, in the time intervals baseline to year 2, year 2 to year 4, and year 4 to year 6, respectively. In the longitudinal mixed model analysis, elevated C-reactive protein level (β = 0.58 [95% confidence interval 0.24, 0.91]) and MRI SI joint osteitis score (β = 0.06 [95% confidence interval 0.03, 0.10]) were independently associated with progression of the sacroiliitis sum score.
Our findings indicate that long-term anti-TNF therapy decelerates the progression of structural damage in the SI joints. Elevated CRP level and presence of osteitis on MRI were independently associated with radiographic sacroiliitis progression.
评估肿瘤坏死因子（TNF）抑制剂依那西普治疗早期轴性脊柱关节炎（SpA）患者长达 6 年的放射学进展，并确定其预测因素。
根据骶髂（SI）关节的放射照片，从 Etanercept 与 Sulfasalazine 在早期轴性 SpA 中的疗效对比（ESTHER）试验中选择接受依那西普治疗长达 6 年的早期轴性 SpA 患者。两名读者根据改良纽约标准（每个 SI 关节 0-4 分）对放射照片进行盲法评分。计算 2 名读者评分的平均值作为骶髂关节炎总分（总分 0-8 分）。根据柏林 MRI 评分系统评估基线、第 2 年和第 4 年时 MRI 上 SI 关节的活动性和慢性炎症改变。
在最初纳入的 76 名患者中，42 名患者在基线时和至少一个随访时间点（第 2 年、第 4 年或第 6 年）有 SI 关节的放射照片。骶髂关节炎总分在基线至第 2 年、第 2 年至第 4 年和第 4 年至第 6 年的平均变化分别为 0.13 ± 0.73、-0.27 ± 0.76 和-0.09 ± 0.68。在纵向混合模型分析中，C 反应蛋白水平升高（β=0.58 [95%置信区间 0.24，0.91]）和 MRI SI 关节骨炎评分（β=0.06 [95%置信区间 0.03，0.10]）与骶髂关节炎总分的进展独立相关。
我们的发现表明，长期抗 TNF 治疗可减缓 SI 关节结构损伤的进展。CRP 水平升高和 MRI 上存在骨炎与放射学骶髂关节炎进展独立相关。
