Abstract
Spondyloarthritis Research Consortium Canada (SPARCC) score is an effective magnetic resonance imaging (MRI) evaluation method for inflammation in axial spondyloarthritis. Previously published meta-analyses have shown tumor necrosis factor α inhibitors (TNFi) had great effectiveness on improving disease activity and function in axial spondyloarthritis. However, there still has no one that concentrates on the impact of TNFi on MRI inflammation. We conduct a meta-analysis to summarize the impact of TNFi on MRI inflammation in axial spondyloarthritis using SPARCC score. Comprehensive search was conducted in the databases of OVID Medline, OVID EMBASE, and Cochrane library on November 14, 2020. We investigated the differences in SPARCC score of sacroiliac joint and spine, before and after TNFi treatment in patients with axial spondyloarthritis. SPARCC score was further compared in the subgroup by diagnostic category and TNFi types. In addition, clinical assessment indicators including ankylosing spondylitis disease activity score, bath ankylosing spondylitis disease activity index, bath ankylosing spondylitis functional index, c-reactive protein were also analyzed. Data were pooled by mean differences (MD) with 95% confidence intervals (CI) and publication bias was assessed by Egger’s test. Jadad scale was applied to assess the quality of included trials. Compared with control group, TNFi significantly improved SPARCC score of sacroiliac joints (n = 11, MD = 2.86, 95% CI 2.50, 3.23) and spine (n = 5, MD = 1.87,95%CI 1.27, 2.46). This effect was consistent among subgroups by different diagnostic category (ankylosing spondylitis, non-radiographic axial spondyloarthritis) and TNFi types (adalimumab, certolizumab pegol). Analysis of clinical assessment indicators also confirmed the therapeutic effect on axial spondyloarthritis. Egger’s test suggested no possibility of publication bias. This meta-analysis shows that TNFi are effective to improve MRI inflammation in patients with axial spondyloarthritis and the treatment effectiveness is not affected by diagnostic category and TNFi types.
Highlights
Spondyloarthritis (SpA), a group of chronic inflammatory rheumatic diseases, affect joints, organs, and other tissues
We investigated the differences in Spondyloarthritis Research Consortium Canada (SPARCC) score of sacroiliac joint and spine, before and after Tumor necrosis factor α inhibitors (TNFi) treatment in patients with axial spondyloarthritis
AxSpA can be further classified to radiographic Axial spondyloarthritis (axSpA), termed ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis based on whether definitive structural changes are visible on plain radiographs of the sacroiliac joints (SIJ)
Summary
Spondyloarthritis (SpA), a group of chronic inflammatory rheumatic diseases, affect joints, organs, and other tissues. AxSpA can be further classified to radiographic axSpA, termed ankylosing spondylitis (AS), and non-radiographic axial spondyloarthritis (nr-axSpA) based on whether definitive structural changes are visible on plain radiographs of the sacroiliac joints (SIJ). Both are characterized by inflammatory pain and functional impairment [1,2,3,4]. For evaluation of inflammation in SIJ reflected by BME, the SPARCC score evaluate the SIJ with highest inflammatory activity, dividing the bilateral joint into 4 quadrants: upper iliac, lower iliac, upper sacral, and lower sacral. To summarize the impact of TNFi on MRI inflammation assessed by SPARCC score, we performed the meta-analysis, accompanied with other assessment indicators including Ankylosing Spondylitis Disease Activity Score (ASDAS), BASDAI, BASFI, and C-reactive protein (CRP)
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