Long-Term Effect of TNF Inhibitors on Radiographic Progression in Ankylosing Spondylitis Is Associated with Syndesmophytes at Baseline and Time-Averaged CRP Levels

Maria Konsta^1,2, Grigorios Sakellariou³, Alexios Iliopoulos⁴, PETROS P SFIKAKIS⁵ and I.E. Van der Horst - Bruinsma⁶, ¹Amsterdam Rheumatology and Immunology Center,VUmc and Reade, Amsterdam, Netherlands, ²First Department of Propaedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Greece, Athens, Greece, ³Rheumatology, Veterans Administration Hospital, Athens, Greece, ⁴Department of Rheumatology, Veterans Administration Hospital, Athens, Greece, ⁵First Department of Propedeutic Internal Medicine, Laikon Hospital, Athens University Medical School, Athens, Greece, ⁶GENRA Consortium, Amsterdam, Netherlands

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Ankylosing spondylitis (AS)

Session Information

Date: Sunday, November 13, 2016

Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster I: Axial and Peripheral Spondyloarthritis – Clinical Aspects, Imaging and Treatment

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Although the radiographic progression in AS is associated with both baseline and time-averaged level of CRP in TNF naïve patients, the effect of level of acute phase reactants on radiographic progression in anti-TNF treated patients has not yet been investigated. The purpose of this study is to investigate whether the impact of long-term treatment with TNF inhibitors on radiographic progression in AS is associated with the level of acute phase reactants.

Methods: Seventy consecutive AS patients with long-standing anti-TNF treatment [47 men; age: 49 ± 11years (mean±SD); disease duration: 25 ± 12 years] were included in this retrospective study. Lateral X-rays of cervical and lumbar spine obtained before anti-TNF initiation were compared to those obtained after a period of 7±2.3 (range: 3-12) years. The levels of CRP and ESR were evaluated at least every 6 months. The radiographic damage was assessed by the mSASSS. New syndesmophyte formation or ΔmSASSS-score/year ≥1 unit/year was defined as radiographic progression. As ΔmSASSS-score/year was defined the difference between mSASSS at last visit and mSASSS at baseline, accounting for the time gap between radiographs. Mann-Whitney test was used to test for the differences in continuous variables between two groups, and Spearman’s coefficient was used for correlations between continuous variables. Additionally, logistic regression analysis was applied.

Results: Thirty-eight AS patients (54%) showed radiographic progression. ΔmSASSS score/year was positively correlated with baseline CRP (r=0.44, p=0.0001) and baseline ESR (r=0.35, p=0.004), as well as with time-averaged CRP (r=0.3, p=0.004). Furthermore, ΔmSASSS score/year was significantly greater (p<0.0001) in patients with syndesmophytes at baseline [1 (0.6-1.8), median (IQR)] compared to those without [0 (0-0.4)]. In multivariate logistic regression analysis, independent risk factors for spinal radiographic progression during anti-TNF treatment were the presence of syndesmophytes at baseline (OR: 9.8, CI: 3-33) and the time-averaged CRP >5mg/L (OR: 6.4, CI: 1.9-21).

Conclusion: In AS patients with long-term anti-TNF treatment, radiographic progression is associated with elevated levels of time-averaged CRP. Furthermore, patients with syndesmophytes at baseline have greater radiographic progression.

Disclosure: M. Konsta, None; G. Sakellariou, None; A. Iliopoulos, None; P. P. SFIKAKIS, None; I. E. Van der Horst - Bruinsma, Pfizer, MSD and AbbVie, 2,AbbVie, MSD, UCB, 5.

To cite this abstract in AMA style:

Konsta M, Sakellariou G, Iliopoulos A, SFIKAKIS PP, Van der Horst - Bruinsma IE. Long-Term Effect of TNF Inhibitors on Radiographic Progression in Ankylosing Spondylitis Is Associated with Syndesmophytes at Baseline and Time-Averaged CRP Levels [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/long-term-effect-of-tnf-inhibitors-on-radiographic-progression-in-ankylosing-spondylitis-is-associated-with-syndesmophytes-at-baseline-and-time-averaged-crp-levels/. Accessed .

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