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“Long-term MRI findings in Ankylosing spondylitis patients treated with TNF inhibitors for a decade”

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Abstract

Objective

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.

Methods

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.

Results

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).

Conclusions

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.

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Open data sharing note

Data from this study are available upon request to the corresponding author.

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Funding

No funding was obtained for this original research.

Author information

Author notes

  1. Maria I. Argyropoulou and Paraskevi V. Voulgari contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, 45500, Greece

    Aliki I. Venetsanopoulou, Zoi Tziortzioti & Paraskevi V. Voulgari

  2. Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece

    Nikoletta E. Anagnostou, Anastasia Zikou & Maria I. Argyropoulou

  3. Department of Medical Physics, Medical School, University of Ioannina, Ioannina, Greece

    Loukas Astrakas

Authors
  1. Aliki I. Venetsanopoulou
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  2. Nikoletta E. Anagnostou
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  3. Zoi Tziortzioti
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  4. Anastasia Zikou
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  6. Maria I. Argyropoulou
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  7. Paraskevi V. Voulgari
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Contributions

Conceived and designed the study: PVV, MIA. Collected the data: ZT, Analyzed and interpreted the data: AZ, NEA. Drafted the manuscript: AIV. Revised the manuscript critically for important intellectual content: PVV, LA. Approved the final version of the manuscript: All authors.

Corresponding author

Correspondence to Paraskevi V. Voulgari.

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Venetsanopoulou, A.I., Anagnostou, N.E., Tziortzioti, Z. et al. “Long-term MRI findings in Ankylosing spondylitis patients treated with TNF inhibitors for a decade”. Rheumatol Int (2024). https://doi.org/10.1007/s00296-023-05530-z

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