Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Fat lesions develop after resolution of inflammation in the spine (1), and have also been shown to predict development of new syndesmophytes (2). Consequently, spinal fat lesions may constitute an important measure of treatment efficacy and a surrogate for structural damage progression. The aim of this study was to investigate the effects of different treatments on development of fat lesions on spinal MRI.
Methods: A total of 135 patients with axial spondyloarthritis (SpA) had MRIs performed with a mean (SD) follow-up of 1.7 (0.8) years. Patients either received no anti-inflammatory treatment (n=12), or were treated with non-steroid anti-inflammatory drugs (NSAIDs) only (n=55), tumor-necrosis-factor-alpha (TNFα) inhibitor only (n=15) or NSAIDs and TNFα inhibitor in combination (n=53). Spinal fat lesions were assessed by the Fat Spondyloarthritis Spine Score (FASSS), where fat lesions are scored based on anatomical location and recorded dichotomously (present/absent) at each vertebral endplate (3). Scoring range per disco-vertebral unit (DVU) for the cervical spine is 0-8, and for the thoracic and lumbar spine: 0-24, resulting in a total score range of 0-456 for all 23 DVUs. Two rheumatologists evaluated pairs of scans blinded to clinical, biochemical or imaging data. Inter-class correlation coefficients were 0.96 (CI 95% 0.94-0.97) for baseline and 0.86 (0.80-0.90) for change scores.
Results: Patients treated only with NSAIDs had significantly shorter disease duration, lower CRP and structural damage on X-rays as assessed by mSASSS as compared to patients treated with TNFα inhibitor alone or in combination with NSAIDs (results not shown, Mann-Whitney test). Patients treated only with NSAIDs had lower FASSS at baseline (p=0.03) and had less change (p=0.01) as compared to patients treated only with TNFα inhibitors (Table 1). Furthermore, significantly more patients treated only with NSAIDs decreased or had no change in FASSS score during follow-up as compared to patients receiving no anti-inflammatory treatment (p=0.009) or TNFα inhibitor alone (p=0.03) (Table 1)(Chi2 test).
Conclusion: Treatment with NSAIDs is associated with a lower propensity to develop fat lesions which could be associated with their effects on new bone formation.
Table 1: FASSS baseline and change scores, and number and frequency of patients with decrease/no change or increase in FASSS scores stratified according to treatment.
|
|
FASSS scores |
Change in FASSS score |
||
|
Treatment group |
Baseline |
Change |
Decreased/no change |
Increased |
|
1: No anti-inflammatory treatment (n=12) |
10.3 (0; 187) |
2.0 (-1; 9.5) |
2 (16.6) |
10 (83.3) |
|
2: NSAIDs only (n=55) |
11.5 (0; 115) |
0 (-9.5; 50) |
32 (58.2) |
23 (41.8) |
|
3: TNFα inhibitor only (n=15) |
18.5 (1; 118) |
8.5 (-8; 51) |
4 (26.7) |
11 (73.3) |
|
4: NSAIDs and TNFα inhibitor (n=53) |
10.0 (0; 93) |
1.5 (-35.5; 34) |
21 (39.6) |
32 (60.4) |
Results are provided a median (range) or N (%).
References: 1. Chiowchanwisawakit et al. ARD 2010; 2. Chiowchanwisawakit et al. AR 2011; 3. Østergaard et al. J Rheum 2009
Disclosure:
S. J. Pedersen,
None;
Z. Zhao,
None;
S. Wichuk,
None;
R. G. Lambert,
None;
W. P. Maksymowych,
None.
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