Heiting Chloe, McMahon Don, Mintz Douglas N, Russell Linda, Ashany Dalit, Yuan Weijia, Mannstadt Insa, Stein Emily M, Goodman Susan M
Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, 535 E 70 Th Street, New York, NY, 10021, USA.
Division of Endocrinology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA.
Arch Osteoporos. 2025 Jun 7;20(1):73. doi: 10.1007/s11657-025-01565-w.
Participants with active AxSpA beginning secukinumab with moderate disease activity had improvements in symptoms, but no substantial change in BMD and microarchitecture. Larger, longer-term controlled studies are needed to assess the impact of IL-17 blockade on skeletal health.
Axial Spondyloarthritis (AxSpA) is linked to poor skeletal health, but whether IL-17 blockade, effective for symptom improvement, improves skeletal health is unknown. We investigated the impact of secukinumab on skeletal features.
We prospectively enrolled AxSpA patients beginning therapy with secukinumab and followed them for 24 months. Clinical assessments, serum bone turnover markers, and cervical and lumbar spine radiographs were obtained. Areal BMD (aBMD) and trabecular bone score (TBS) measured by dual energy x-ray absorptiometry (DXA, spine, hip, forearm), volumetric BMD (vBMD), and microarchitecture measured by high-resolution peripheral quantitative computed tomography (HR-pQCT, Xtreme CT2, at the tibia and radius) were performed annually. DXA and HR-pQCT assessments were compared to reference cohorts of sex- and age-matched individuals. Changes were assessed through Wilcoxon and paired t-tests.
Thirty AxSpA participants were enrolled, 50% female (13% postmenopausal) and 47% HLA-B27 positive. Mean symptom duration was 12 years, with moderate activity (BASDAI mean 5 [SD = 2]). Baseline DXA and HR-pQCT Z-scores were within 1 standard deviation of sex- and age-matched controls. BASDAI (- 33%, p < 0.01) and BASMI (- 22%, p = 0.01) improved, but there was no improvement in aBMD, TBS, or microarchitecture. By HR-pQCT, vBMD decreased (- 0.6%, p = 0.04), and cortical porosity increased (8.3%, p = 0.03). New vertebral fractures were not observed.
患有活动性轴向性脊柱关节炎（AxSpA）且疾病活动度为中度的患者在开始使用司库奇尤单抗治疗后症状有所改善，但骨密度（BMD）和骨微结构无实质性变化。需要开展更大规模、更长期的对照研究来评估白细胞介素-17（IL-17）阻断对骨骼健康的影响。
轴向性脊柱关节炎（AxSpA）与骨骼健康状况不佳有关，但能有效改善症状的IL-17阻断是否能改善骨骼健康尚不清楚。我们研究了司库奇尤单抗对骨骼特征的影响。
我们前瞻性招募了开始使用司库奇尤单抗治疗的AxSpA患者，并对他们进行了24个月的随访。进行了临床评估、血清骨转换标志物检测以及颈椎和腰椎X线片检查。每年通过双能X线吸收法（DXA，测量脊柱、髋部、前臂）测量面积骨密度（aBMD）和小梁骨评分（TBS），通过高分辨率外周定量计算机断层扫描（HR-pQCT，Xtreme CT2，测量胫骨和桡骨）测量体积骨密度（vBMD）和骨微结构。将DXA和HR-pQCT评估结果与年龄和性别匹配的参考队列进行比较。通过Wilcoxon检验和配对t检验评估变化情况。
共招募了30名AxSpA参与者，其中50%为女性（13%为绝经后女性），47% HLA-B27阳性。平均症状持续时间为12年，疾病活动度为中度（巴斯强直性脊柱炎疾病活动指数（BASDAI）平均为5 [标准差（SD）=2]）。基线DXA和HR-pQCT的Z评分在年龄和性别匹配对照组的1个标准差范围内。BASDAI（-33%，p<0.01）和巴斯强直性脊柱炎功能指数（BASMI）（-22%，p=0.01）有所改善，但aBMD、TBS或骨微结构无改善。通过HR-pQCT检查，vBMD下降（-0.6%，p=0.04），皮质骨孔隙率增加（8.3%，p=0.03）。未观察到新的椎体骨折。
