Background/Purpose: Lower limbs enthesis by ultrasound (US) detects inflammatory activity in patients with spondyloarthritis(SpA) and is a diagnostic tool of early SpA. The present objective was to follow SpA patients starting anti-TNF inhibitors with US and clinical assessments to explore whether any variable in baseline or early stage could predict later favorable responses.

Methods: This study is prospective and US reader and clinical physician blinded study. Patients with SpA starting anti-TNF inhibitors were consecutively included and examined at baseline and, after 1 and 12 weeks with standardized bilateral ultrasound of six enthesis (Madrid sonography enthesitis index (MASEI)). In addition, the patients were assessed clinically with ASDAS, assessor global VAS (study nurse), ESR and CRP. Patients with ASDAS clinical important improvement at the 12 weeks examination was defined as responders. The results of US score (MASEI), clinical and laboratory assessments at baseline and after 1 week were explored by Mann-Whitney tests to examine for associations with the responders.

Results: A total of 45 patients were included (mean (SD) age 60.3 (25.2) years, disease duration14.2 (6) years, and 35% women, with 73% using infliximab and 27% adalimumab).A total of 69 % of the patients were defined as ASDAS responders, and they had significantly lower US score (MASEI) (p=0.03), assessor global VAS (study nurse) (p=0.02), and CRP (p=0.02)at the 12 weeks examination. Baseline US score (MASEI), ASDAS, assessor global VAS, ESR or CRP did not separate between responders and non-responders. At 1 week examination the only variable differing between responders and non-responders was the US score (MASEI), with a significant reduction in US score (MASEI) in the responders versus non-responders 12.6 (5.4) versus 2.3(3.3) (p=0.03).

Conclusion: US enthesis images at 1 week after TNF inhibitors in patients with SpA are useful to identify later good responders.

References: Alcalde M, Acebes JC, Cruz M, et al. A sonographic enthesitic index of lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann Rheum Dis 2007 ; 66 : 1015 – 19 .Machado P, Landewé R, Lie E, Kvien TK et al. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis. 2011 ;70:47-53

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/early-improvements-in-the-lower-limbs-enthesis-by-ultrasound-predicting-later-favorable-responses-in-tnf-inhibotors-treated-patients-with-spondyloarthritis/