Sacroiliac Joint Ankylosis in Young Spondyloarthritis Patients Receiving Biologic Therapy: Observation of Serial Magnetic Resonance Imaging Scans.

Timothy J P Bray,Corinne Fisher,Margaret A Hall‐Craggs,Coziana Ciurtin,Andre Lopes,Debajit Sen

doi:10.1002/art.40750

Timothy J P Bray, Corinne Fisher + Show 4 more

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https://doi.org/10.1002/art.40750

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Abstract

ObjectiveTo assess the temporal relationship between initiating biologic therapy and magnetic resonance imaging (MRI) scores of inflammation and structural damage in young patients with spondyloarthritis.MethodsA local adolescent/young adult patient rheumatology database was searched for patients ages 12–24 years who had evidence of sacroiliitis on MRI and a clinical diagnosis of enthesitis‐related arthritis (ERA) with axial involvement or nonradiographic axial spondyloarthritis. Patients treated with tumor necrosis factor inhibitor (TNFi) therapy who had undergone a minimum of 1 MRI scan before and 2 MRI scans after starting TNFi therapy (over ≥2 years) were included. Images of the sacroiliac joints were scored for inflammation and structural abnormalities (including erosions, fat metaplasia, and fusion). The effects of TNFi therapy and of time since initiation of TNFi therapy on inflammation and structural abnormalities were assessed using a mixed‐effects regression analysis.ResultsTwenty‐nine patients (ages 12–23 years) with ERA or nonradiographic axial spondyloarthritis who underwent TNFi therapy were included. Inflammation scores were significantly lower in patients receiving TNFi treatment (P = 0.013), but there was no significant effect of time from TNFi initiation on inflammation (P = 0.125). Conversely, there was no significant effect of active TNFi treatment on fusion scores (P = 0.308), but fusion scores significantly increased with time from TNFi initiation (P < 0.001); a similar positive relationship between time since biologic start and fat metaplasia scores was observed.Conclusion TNFi therapy failed to prevent the eventual development of joint ankylosis in this cohort of young patients with spondyloarthritis, despite a substantial reduction in inflammation with TNFi therapy.

Highlights

The spondyloarthritides are a group of immune-mediated inflammatory disorders that are characterized by inflammation of the spine, entheses, and peripheral joints
The spondyloarthritides encompass a wide range of disease phenotypes, each of which varies in terms of disease severity, the presence of structural damage, and age at presentation
We observed that tumor necrosis factor inhibitor (TNFi) therapy did not prevent the eventual fusion of the sacroiliac joints in patients with enthesitis-related arthritis (ERA), despite there being relatively little structural damage at presentation and despite the fact that inflammation was substantially reduced by TNFi treatment

Summary

Introduction

The spondyloarthritides are a group of immune-mediated inflammatory disorders that are characterized by inflammation of the spine, entheses, and peripheral joints. Ankylosing spondylitis (AS) is the “prototypic” spondyloarthritis and causes ankylosis (fusion) of the axial skeleton with subsequent disability, morbidity, and impaired quality of life [1]. Ankylosis may be less severe or absent in other spondyloarthritis subgroups, suggesting that these groups represent a milder or earlier form of the disease [1]. The views expressed in this publication are those of the authors and not necessarily those of the UK Department of Health. Dr Hall-Craggs’ work was supported by the NIHR University College London Hospital Biomedical Research Center

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