VIB Center for Inflammation Research, Ghent University, and Ghent University Hospital, Ghent, Belgium.
Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark, and University of Copenhagen, Copenhagen, Denmark.
Arthritis Rheumatol. 2021 Nov;73(11):2044-2051. doi: 10.1002/art.41783. Epub 2021 Sep 22.
This study was undertaken to assess the inflammatory burden in peripheral spondyloarthritis (SpA) by magnetic resonance imaging (MRI) of the legs in an early remission-induction strategy study of tumor necrosis factor (TNF) blockade. Furthermore, we sought to determine the value of MRI to predict disease relapse versus sustained remission after treatment discontinuation.
Thirty-two patients with early peripheral SpA with involvement of the legs determined on clinical examination and confirmed by ultrasonography (US) participated in a remission-induction trial of a TNF inhibitor (TNFi). Patients underwent MRI of the joints and entheses of the legs at baseline and at clinical remission, after which TNFi treatment was withdrawn. Images were evaluated for joint effusion, joint osteitis, entheseal soft tissue inflammation, and entheseal osteitis.
Joint effusion and enthesitis on clinical examination and US correlated well with MRI abnormalities. In addition, a substantial amount of subclinical involvement was seen on MRI, mainly in the ankle joints and heel entheses. Inflammation scores were markedly lower in the subclinically involved joints and entheses versus those that were clinically involved (P values ranged from 0.01 to <0.001). Inflammatory load on MRI decreased significantly upon TNFi treatment (P < 0.001). Whereas 80% of the joints that were clinically involved at baseline showed no effusion on remission MRI, 2 of 3 entheses involved at baseline showed residual inflammation. In addition, patients who experienced a relapse after treatment discontinuation displayed more entheseal soft tissue inflammation on remission MRI compared to those who maintained drug-free remission (P = 0.028).
Our findings delineate a differential response of synovitis and enthesitis, with enthesitis on MRI being less responsive to TNFi treatment. Furthermore, residual entheseal inflammation might be indicative of the need for continuous therapy.
本研究通过 TNF 阻滞剂的腿部外周 SpA 早期缓解诱导策略研究的腿部磁共振成像（MRI）评估炎症负担。此外，我们还试图确定 MRI 在预测治疗停药后疾病复发与持续缓解方面的价值。
32 例经临床检查和超声（US）证实的下肢早期外周 SpA 患者参与了 TNF 抑制剂（TNFi）的缓解诱导试验。患者在基线和临床缓解时接受腿部关节和附着点的 MRI 检查，然后停用 TNFi 治疗。对关节积液、关节骨炎、附着点软组织炎症和附着点骨炎进行图像评估。
临床检查和 US 上的关节积液和附着点炎与 MRI 异常密切相关。此外，MRI 上还可见大量亚临床受累，主要在踝关节和跟腱附着点。与临床受累关节和附着点相比，亚临床受累关节和附着点的炎症评分明显较低（P 值范围为 0.01 至 <0.001）。TNFi 治疗后炎症负荷显著降低（P < 0.001）。尽管 80%的基线临床受累关节在缓解 MRI 上无积液，但基线时有 2 个附着点受累。此外，停药后复发的患者在缓解 MRI 上显示出更多的附着点软组织炎症，与维持无药物缓解的患者相比（P = 0.028）。
我们的研究结果描绘了滑膜炎和附着点炎的不同反应，MRI 上的附着点炎对 TNFi 治疗的反应性较低。此外，残留的附着点炎症可能表明需要持续治疗。
