Background/Purpose: The follow-up of axial spondyloarthritis (SpA) remains difficult in clinical practice, mainly based on patient-reported outcomes, whereas objective parameters in disease monitoring are often lacking, especially in axial manifestations. MRI of the spine and sacroiliac joints (SIJ) might be relevant for difficult cases, provided that its validity and correlation with clinical, biological parameters, functional and activity scores is ascertained.

The aim of this study was to assess the effect of TNF alpha inhibitors (TNF-) on MRI scoring of inflammation on spine and SIJ and to evaluate their correlation with the clinical and biological parameters used in daily practice.

Methods: A systematic review of the literature using PUBMED and the Cochrane library as well as proceedings from recent major relevant congresses was performed until January 2015. All randomized controlled trials and controlled cohorts reporting the effect of TNF- on spine and SIJ MRI scores (ASspiMRI, SPARCC, Berlin) were selected. Data were collected using a predetermined form. The outcomes were: the change in scores between baseline and follow up in TNF- and control groups, the correlation of theses changes with CRP, ESR, BASDAI, BASFI, ASDAS, pain and morning stiffness. When appropriate, statistical analysis determined the pooled therapeutic effect of TNF- on MRI scores computed by meta-analysis.

Results: Out of 365 screened references, 58 studies were included : 14 using ASspiMRI score, 8 using spine SPARCC score, 8 using SPARCC SIJ score, 7 using BERLIN spine score, 7 using BERLIN SIJ score and 14 using other scores. In ASspiMRi at 12 weeks and 2years follow up, and in SPARCC spine score at 12 weeks follow up a non significant difference in MRI score decrease between the TNF alpha inhibitor group and control group was reported. A significant decrease in the SPARCC SIJ score at 12 weeks in TNF alpha inhibitor group was reported. The correlation between MRI spine and SIJ scores on one side, and the clinical and biological data on the other side was very heterogeneous across the different reports. However, an association was usually reported between the MRI scores and CRP, ESR and ASDAS.

Conclusion: Considering our findings, MRI (especially MRI of the spine) seems to insufficiently reflect the axial activity of SpA patients to recommend its use in individual follow-up or assessment of patients. Regarding its diagnostic value or relevance in the apprehension of the pathophysiology of the disease however, it remains currently the most accurate tool.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/change-in-mri-in-patients-with-spondyloarthritis-treated-with-anti-tnf-agents-systematic-review-of-the-literature/