Department of Rheumatology, CHU Montpellier, Montpellier University, France.
Clin Exp Rheumatol. 2021 Mar-Apr;39(2):242-252. doi: 10.55563/clinexprheumatol/fsluso. Epub 2021 Jan 21.
Magnetic resonance imaging (MRI) is currently the most accurate imaging tool used in axial spondyloarthritis regarding its diagnostic approach. MRI of the spine and sacroiliac joints (SIJ) might be relevant in the follow-up of axial spondyloarthritis for difficult cases, provided that its validity and correlation with clinical, biological and functional outcomes is ascertained. The aim of this study was to assess the effect of TNF alpha inhibitors (TNFi) on MRI scoring of inflammation on spine and SIJ and to evaluate their correlation with the parameters used in daily practice.
A systematic review of the literature using PUBMED and the Cochrane library was performed until January 2016. All randomised controlled trials and controlled cohorts reporting the effect of TNFi on spine and SIJ MRI scores [Ankylosing Spondylitis spine MRI (ASspiMRI), Spondyloarthritis Research Consortium of Canada (SPARCC), and Berlin] were selected. The collected outcomes were: the change in scores between baseline and follow-up in TNFi and control groups, the correlation of these changes with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index/Functional Index (BASDAI/BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS), pain and morning stiffness. When appropriate, statistical analysis determined the pooled therapeutic effect of TNFi on MRI scores computed by meta-analysis.
Of 39 screened references, 55 studies were included. In studies using ASspiMRI at 12-week and 2-year follow-up, and in those using SPARCC spine score at 12-week follow-up, a non-significant decrease in MRI score between the TNFi group and control group was reported (p=0.36; p=0.73; p=0.12, respectively). Only a significant decrease in the SPARCC SIJ score was reported at 12 weeks in the TNFi group versus control (p<0.0001). The correlation between MRI spine and SIJ scores on the one hand, and the clinical and biological data on the other was very heterogeneous across the different reports. However, an association was usually reported between the MRI scores and CRP, ESR and ASDAS.
There is not sufficient evidence to distinguish the difference between changes in MRI inflammatory lesions of the spine and SIJ in patients with axial SpA related to TNF alpha inhibitor effects and those due to the natural course of the disease activity (alternating periods of flares and remission in axial SpA).
磁共振成像（MRI）是目前用于轴向脊柱关节炎诊断的最准确的影像学工具。对于难处理的病例，脊柱和骶髂关节（SIJ）的 MRI 可能对轴向脊柱关节炎的随访有用，但前提是确定其有效性及其与临床、生物学和功能结果的相关性。本研究旨在评估 TNF-α抑制剂（TNFi）对脊柱和 SIJ 炎症 MRI 评分的影响，并评估其与日常实践中使用的参数的相关性。
使用 PUBMED 和 Cochrane 图书馆对文献进行系统综述，检索时间截至 2016 年 1 月。所有报告 TNFi 对脊柱和 SIJ MRI 评分[强直性脊柱炎脊柱 MRI（ASspiMRI）、加拿大脊柱关节炎研究协会（SPARCC）和柏林]影响的随机对照试验和对照队列研究均被纳入。收集的结果是：TNFi 组和对照组在基线和随访时评分的变化，这些变化与 C 反应蛋白（CRP）、红细胞沉降率（ESR）、巴斯强直性脊柱炎疾病活动指数/功能指数（BASDAI/BASFI）、强直性脊柱炎疾病活动评分（ASDAS）、疼痛和晨僵的相关性。在适当的情况下，通过荟萃分析计算 TNFi 对 MRI 评分的治疗效果的汇总。
在筛选出的 39 篇参考文献中，有 55 篇研究被纳入。在使用 ASspiMRI 进行 12 周和 2 年随访的研究中，以及使用 SPARCC 脊柱评分进行 12 周随访的研究中，报告 TNFi 组和对照组之间 MRI 评分无显著下降（p=0.36；p=0.73；p=0.12）。仅在 TNFi 组与对照组相比，SPARCC SIJ 评分在 12 周时显著下降（p<0.0001）。在不同的报告中，MRI 脊柱和 SIJ 评分与临床和生物学数据之间的相关性非常不一致。然而，通常报告 MRI 评分与 CRP、ESR 和 ASDAS 之间存在相关性。
目前没有足够的证据可以区分与 TNF-α抑制剂作用相关的脊柱关节炎患者脊柱和骶髂关节炎症性 MRI 病变变化与疾病活动自然病程（轴向脊柱关节炎的交替发作和缓解期）之间的差异。
