Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, 45500, Greece.
Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece.
Rheumatol Int. 2024 Nov;44(11):2583-2589. doi: 10.1007/s00296-023-05530-z. Epub 2024 Jan 31.
This study aims to evaluate the active and chronic lesions in sacroiliac joints and lumbar spine over a decade of TNFi therapy in patients with AS.
The study enrolled patients with AS under treatment with a TNFi for over a decade. The patients underwent a new MRI scan of their lumbar spine and sacroiliac joint (SIJ). Two readers evaluated all images. Inflammation of SIJ (SIS), SIJ structural damage (SSS) including Fat Metaplasia, Erosions, Backfill and Ankylosis, and Spondyloarthritis Research Consortium of Canada Bone marrow edema (SPARCC) spine score were recorded.
In the study, 15 patients were included, with 80% being male. The mean age during their first MRI was 38.1 (± 11.9) years old, and the majority (86.7%) tested positive for HLA-B27. While TNFi improved both BASDAI and BASFI scores, there was a noticeable increase in MRI acute lesions in the SIJ over time, where the median score increased from 0 (0-4) to 3 (0-10) after ten years (p = 0.028). After a decade of treatment, the median SPARCC spine score also increased from 0 (0-9) to 5 (0-16), p = 0.093. Finally, it was observed that there was a significant positive correlation between ESR and SIS erosions in cases of chronic lesions (r = 0.819, p < 0.001).
While TNFi have significantly improved the treatment of AS, this study shows that acute lesions can still develop despite treatment. A personalized approach that adapts MRI assessment to each patient's specific requirements may help detect changes early and enable doctors to intervene promptly to prevent further damage.
本研究旨在评估强直性脊柱炎患者接受 TNFi 治疗超过十年后，其骶髂关节和腰椎的活动性和慢性病变情况。
本研究纳入了接受 TNFi 治疗超过十年的强直性脊柱炎患者。患者接受了新的腰椎和骶髂关节（SIJ）MRI 扫描。两名读者评估了所有图像。记录了 SIJ 炎症（SIS）、SIJ 结构损伤（SSS），包括脂肪化生、侵蚀、填充和强直，以及加拿大脊柱关节炎研究协会骨髓水肿（SPARCC）脊柱评分。
本研究共纳入 15 名患者，其中 80%为男性。他们首次 MRI 时的平均年龄为 38.1（±11.9）岁，大多数（86.7%）HLA-B27 阳性。虽然 TNFi 改善了 BASDAI 和 BASFI 评分，但随着时间的推移，SIJ 的 MRI 急性病变明显增加，中位数评分从十年前的 0（0-4）增加到 3（0-10）（p=0.028）。经过十年的治疗，SPARCC 脊柱评分中位数也从 0（0-9）增加到 5（0-16），p=0.093。最后，观察到慢性病变时 ESR 与 SIS 侵蚀之间存在显著正相关（r=0.819，p<0.001）。
虽然 TNFi 显著改善了强直性脊柱炎的治疗效果，但本研究表明，即使接受治疗，仍可能出现急性病变。采用个性化方法，根据每位患者的具体需求调整 MRI 评估，可能有助于早期发现变化，并促使医生及时干预，以防止进一步的损伤。
