Abstract
In recent years, MRI has been regarded as a major diagnostic tool for spondyloarthritis (SpA), and anti-TNF therapy has been widely confirmed as an effective treatment strategy. This study was designed to investigate the correlation between the secreted protein dickkopf-1 (Dkk-1) and abnormal findings on magnetic resonance imaging (MRI) through a prospective study of 30 cases of SpA. Thirty patients with active SpA were included, all treated with recombinant human tumor necrosis factor (TNF) receptor-antibody fusion protein (YiSaiPu) injection at 50 mg/week for 6 months. All patients were also examined for their clinical, serological, and imaging manifestations of the condition before and after treatment. In patients receiving TNF inhibitor treatment, the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and clinical activity indices BASDAI, BASFI, BASMI, ASDAS-CRP were significantly decreased (p < 0.01). Serum Dkk-1 concentration was also significantly decreased (p < 0.05), as were the scores of bone marrow edema of the sacroiliac joints and the spine (p < 0.05). The score of sacroiliac joint backfill was significantly increased (p < 0.05), and the baseline and changes in the serum Dkk-1 concentration were significantly correlated with the baseline and changes in spinal bone marrow edema levels. Inhibition of the level of serum Dkk-1 by TNF inhibitors may be the molecular basis for inhibiting the formation of new bone in SpA patients. In addition, spinal marrow edema may have significance for predicting new bone formation.
Highlights
In recent years, the latest advances in the diagnosis and treatment of spondyloarthritis (SpA) have been using magnetic resonance imaging (MRI) as the major diagnostic tool and administering anti- tumor necrosis factor (TNF) therapy as the major treatment strategy
All patients were scored for bone marrow edema, fat infiltration, bone erosion, backfill, and stiffness on MRI imaging of the sacroiliac joints
All patients were scored for bone marrow edema and fat infiltration on spinal MRI imaging
Summary
The latest advances in the diagnosis and treatment of spondyloarthritis (SpA) have been using MRI as the major diagnostic tool and administering anti- tumor necrosis factor (TNF) therapy as the major treatment strategy. Recent prospective data suggest that the spinal inflammatory damage in patients with ankylosing spondylitis (AS) will be eventually converted into fat. In these complex inflammatory lesions, bone formation and inflammation are not synchronized. The serum level of Dkk-1, the natural inhibitor of Wnt protein, may be a main factor in blocking new bone formation. Current research suggests that spinal inflammation repair, such as fat infiltration, may further stimulate syndesmophyte formation or calcification [1, 2]. This study was designed to investigate the molecular mechanism underlying the TNF inhibitors’ blockade on new bone formation, and to provide information for evaluating prognosis and choosing appropriate therapy for patients with SpA
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