Session Information
Session Title: Spondylarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment: Spondyloarthritis I
Session Type: Abstract Submissions (ACR)
Background/Purpose: Clinical trial results suggest that new bone formation is neither inhibited nor augmented by anti-TNF agents in ankylosing spondylitis (AS). Recently, a potential role of different inflammatory lesions such as inflammation (INF) and fatty degeneration (FD) to predict new bone formation in patients with active AS was suggested. This is the first study to analyze the relationship between INF and FD as assessed by magnetic resonance imaging (MRI) and syndesmophyte formation as assessed by conventional radiography in vertebral edges (VE) of AS patients under long-term anti-TNF treatment.
Methods: Images were scored blinded for the time point of investigation of MRIs and x-rays of patients who participated in the EASIC Registry. Most patients were treated with infliximab. Presence or absence of INF, FD and syndesmophytes was documented on the level of VEs in the anterior part of the spine at each time point. Data were compared using Fisher´s exact test after adjustment for within-patient variation. Relative risk (RR) calculation based on a general linear model and Poisson variation.
Results: Complete sets of MRIs of 73 AS patients were evaluated at BL and 2y (1,526 VEs, 89 with and 1,437 without syndesmophytes or ankylosis at BL) and were related to complete sets of conventional radiographs of the same patients at BL, 2y and 5y. The amount of VEs with INF decreased significantly from 22.5% at BL to 1.5% after 2y, while in contrast, the amount of VEs with FD increased from 23.9% (n=364) at BL to 32.4% at 2y. In parallel, the VEs with syndesmophytes increased from 5.3% to 7.7% between BL and 2y. Overall, 35 and 60 new syndesmophytes developed after 2y and 5y, respectively, from VEs without baseline radiographic damage. The most frequent MRI pathology for syndesmophyte development at BL was the parallel occurrence of both MRI lesions, INF and FD: 22.9% and 16.7% at 2y and 5y, respectively. On the other hand, most of the new syndesmophytes (57.1% after 2y and 58.3% after 5y) seen on radiographs showed neither FD nor INF at BL. Syndesmophyte occurrence at baseline was the only significant predictor for development of these new syndesmophytes. The RR for syndesmophyte development was significant for the occurrence of the FD/INF combination at both follow-up time points, with a RR of 5.0 (p=0.002) after 2y and RR of 3.3 (p=0.009) after 5y, but only if FD lesions remained unchanged under anti-TNF treatment at 2y. On the other hand, no new syndesmophyte developed after 2y or 5y when INF was resolved. Importantly, we saw no new syndesmophyte developing after resolution of inflammation and evolution of new FD at the same VE.
Conclusion: Both spinal inflammation and fatty degeneration were associated with syndesmophyte development but fatty degeneration showed the highest risk for new syndesmophytes. However, >50% of the new bone formation observed in under anti-TNF treatment over 5 years was not preceded by either one of those. Overall, rather few syndesmophytes developed over 5 years in AS patients treated with anti-TNF. The sequence of INF – FD – new bone formation under anti-TNF was not seen at all. It seems that anti-TNF treatment has a more beneficial effect in the process of bone formation in patients with early (INF) but not late (FD) stages of the disease.
Disclosure:
X. Baraliakos,
Janssen Pharmaceutica Product, L.P.,
2;
F. Heldmann,
Janssen Pharmaceutica Product, L.P.,
2;
J. Listing,
None;
J. Callhoff,
None;
J. Braun,
Janssen Pharmaceutica Product, L.P.,
2;
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-relationship-of-inflammation-fatty-degeneration-and-the-effect-of-long-term-tnf-blocker-treatment-on-the-development-of-new-bone-formation-in-patients-with-ankylosing-spondylitis/