University Dusseldorf, Dusseldorf, Germany.
University of Duisburg-Essen, Essen, Germany.
Arthritis Rheumatol. 2022 Sep;74(9):1497-1505. doi: 10.1002/art.42149. Epub 2022 Jul 28.
Proof-of-concept trial to determine the effects of tumor necrosis factor inhibitor (TNFi) therapy on osteoblastic activity at sites of inflammatory and structural lesions in patients with radiographic axial spondyloarthritis (SpA), using fluorine 18-labeled NaF ( F-NaF) positron emission tomography/magnetic resonance imaging (PET/MRI).
Sixteen patients with clinically active radiographic axial SpA were prospectively enrolled to receive TNFi treatment and undergo F-NaF PET/MRI of the sacroiliac (SI) joints and spine at baseline and at a follow-up visit 3-6 months after treatment initiation. Three readers (1 for PET/MRI and 2 for conventional MRI) evaluated all images, blinded to time point. Bone marrow edema, structural lesions (i.e., fat lesions, sclerosis, erosions, and ankylosis), and F-NaF uptake at SI joint quadrants and vertebral corners (VCs) were recorded.
Overall, 11 male and 5 female patients (mean age ± SD 38.6 ± 12.0 years) were followed up for a mean duration of 4.6 months (range 3-6). F-NaF PET/MRI was conducted on SI joints for 16 patients and the spine for 10; 128 SI joint quadrants and 920 VCs were analyzed at each time point. At baseline, F-NaF uptake was demonstrated in 96.0% of SI joint quadrants with bone marrow edema, 94.2% with sclerosis, and 88.3% with fat lesions. At follow-up, 65.3% of SI joint quadrants with bone marrow edema (P < 0.001), 33.8% with sclerosis (P = 0.23), and 24.5% with fat lesions (P = 0.01) had less F-NaF uptake, compared with baseline. For VCs, F-NaF uptake at baseline was found in 81.5% of edges with sclerosis, 41.9% with fat lesions, and 33.7% with bone marrow edema. At follow-up, 73.5% of VCs with bone marrow edema (P = 0.01), 53.3% with fat lesions (P = 0.03), and 55.6% with sclerosis (P = 0.16) showed less F-NaF uptake, compared with baseline.
Anti-TNF antibody treatment led to a significant decrease in osteoblastic activity within 3-6 months, especially, but not solely, at sites of inflammation. Larger data sets are needed for confirmation of the antiosteoblastic effects of TNFi for the prevention of radiographic progression in axial SpA.
通过氟 18 标记的氟化钠（ ¹⁸F-NaF）正电子发射断层扫描/磁共振成像（PET/MRI）检测炎症和结构病变部位的成骨活性，确定肿瘤坏死因子抑制剂（TNFi）治疗对影像学轴性脊柱关节炎（SpA）患者的影响。
前瞻性纳入 16 例临床活动期影像学轴性 SpA 患者，接受 TNFi 治疗，并在基线和治疗开始后 3-6 个月时进行 ¹⁸F-NaF PET/MRI 骶髂（SI）关节和脊柱检查。3 位读者（1 位用于 PET/MRI，2 位用于常规 MRI）对所有图像进行盲法评估。记录骨髓水肿、结构病变（脂肪病变、硬化、侵蚀和强直）和 SI 关节象限和椎体角（VCs）的 ¹⁸F-NaF 摄取。
共纳入 11 例男性和 5 例女性患者（平均年龄 38.6±12.0 岁），平均随访 4.6 个月（3-6 个月）。16 例患者进行了 SI 关节 PET/MRI，10 例患者进行了脊柱 PET/MRI；在每个时间点分析了 128 个 SI 关节象限和 920 个 VCs。基线时，96.0%的骨髓水肿 SI 关节象限、94.2%的硬化 SI 关节象限和 88.3%的脂肪病变 SI 关节象限显示 ¹⁸F-NaF 摄取。随访时，与基线相比，65.3%的骨髓水肿 SI 关节象限（P<0.001）、33.8%的硬化 SI 关节象限（P=0.23）和 24.5%的脂肪病变 SI 关节象限（P=0.01）的 ¹⁸F-NaF 摄取减少。对于 VCs，基线时硬化 VC 边缘的 ¹⁸F-NaF 摄取率为 81.5%，脂肪病变 VC 为 41.9%，骨髓水肿 VC 为 33.7%。随访时，骨髓水肿 VC 中 73.5%（P=0.01）、脂肪病变 VC 中 53.3%（P=0.03）和硬化 VC 中 55.6%（P=0.16）的 ¹⁸F-NaF 摄取减少，与基线相比。
抗 TNF 抗体治疗在 3-6 个月内导致成骨活性显著下降，尤其是炎症部位，但不仅限于炎症部位。需要更大的数据集来证实 TNFi 的抗成骨作用，以预防影像学轴性 SpA 的进展。
