Background/Purpose: The adipose tissue immune properties and pharmacokinetic consequences can contribute to the pathogenesis of inflammatory conditions. The hole of fat tissue in active Ankylosing Spondylitis (AS) patients and its influence on response to anti-TNF therapy has not been widely investigated. The purpose of this study was to evaluate the fat tissue in active AS patients and the influence on clinical response to TNF blockade therapy.

Methods: 37 patients with active AS referred to receive anti-TNF therapy with high/very high disease activity according to AS Disease Activity Score (ASDAS > 2.1) and have completed 6 months of treatment were included. At baseline patients were evaluated for weight, height, body mass index (BMI), waist circumference, body composition (DXA) including total fat and trunk fat. Factors related to adipocytokines and inflammation (leptin, resistin, adiponectin, TNFα and IL-6) were also evaluated at baseline. Disease parameters and inflammatory markers [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)] were assessed at baseline and after 6 months of treatment. Responders to anti-TNF therapy were defined according to ASDAS improvement criteria with Δ ASDAS ≥ 2.0.

Results:

Patients had a mean age of 37.0 ± 12.1 years, 75.7% were male with a mean of 9.0 ± 9.8 years of disease duration. At baseline patients had [mean (SD)]: weight 70.4(11.9)kg, BMI 26.1(4.3)kg/m2, waist circumference 89.0(10.4)cm, total fat 18.9(6.6)kg and trunk fat mass 19.5(6.7)kg. Regarding disease parameters, the mean ASDAS value was 3.2(0.9), BASFI 4.4(2.4) and BASMI 4.4(2.7). After 6 months of anti-TNF treatment 12 (32.4%) patients reached major improvement by ASDAS criteria. Comparing responders and non-responders groups we observed that the patients with good response had lower BMI (p=0.01), waist circumference (p=0.005), trunk fat mass (0.03) and higher resistin (p=0.02) serum levels and infflmmatory parameters [CRP (p=0.02) and ESR (p=0.01)]. Resistin serum levels at baseline correlated with CRP (r=0.58, p<0.01) and ESR (r=0.37, p=0.02).

Conclusion: This study provides evidence that fat mass and resistin serum levels may predict the anti-TNF response in AS patients. Further studies are necessary to elucidate the mechanism by which adipose tissue affects inflammatory condition in AS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fat-mass-and-resistin-predictive-factors-for-anti-tnf-therapy-response-in-ankylosing-spondylitis-patients/