Spinal inflammation by magnetic resonance imaging in patients with ankylosing spondylitis: association with disease activity and outcome parameters

2011 ◽  
Vol 32 (12) ◽  
pp. 3765-3770 ◽  
Author(s):  
Şefika Konca ◽  
Dilek Keskin ◽  
Deniz Cılız ◽  
Hatice Bodur ◽  
Bülent Sakman
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ankylosing Spondylitis ◽  
Magnetic Resonance ◽  
Disease Activity ◽  
Resonance Imaging ◽  
Outcome Parameters ◽  
Spinal Inflammation

Low-dose Infliximab (3 mg/kg) Significantly Reduces Spinal Inflammation on Magnetic Resonance Imaging in Patients with Ankylosing Spondylitis: A Randomized Placebo-controlled Study

2010 ◽  
Vol 37 (8) ◽  
pp. 1728-1734 ◽  
Author(s):  
WALTER P. MAKSYMOWYCH ◽  
DAVID SALONEN ◽  
ROBERT D. INMAN ◽  
PROTON RAHMAN ◽  
ROBERT G.W. LAMBERT
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ankylosing Spondylitis ◽  
Magnetic Resonance ◽  
Treatment Effect ◽  
Low Dose ◽  
High Reliability ◽  
Controlled Study ◽  
Resonance Imaging ◽  
Large Treatment Effect ◽  
Spinal Inflammation

Objective.To evaluate the influence of low-dose infliximab (IFX) on spinal inflammation scored by magnetic resonance imaging (MRI). The dose recommended for rheumatoid arthritis (3 mg/kg) is also clinically effective for ankylosing spondylitis (AS), although effects on spinal inflammation as defined by MRI have yet to be described in a placebo-controlled trial.Methods.In a 12-week double-blind period, patients were randomized 1:1 to receive either IFX 3 mg/kg at 0, 2, and 6 weeks, or placebo. Spinal inflammation in discovertebral units (DVU) was measured by the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI Index at baseline and 12 weeks by 3 readers blinded to timepoint and treatment allocation. We also compared reliability and discrimination of the SPARCC MRI index based on evaluation of the entire spine (23 DVU score) compared to assessment of only the 6 most severely affected DVU (6 DVU score).Results.At Week 12, patients treated with IFX experienced mean reductions of 55.1% and 57.2% in the 6 DVU and 23 DVU SPARCC scores, respectively, compared with a mean increase of 5.8% and decrease of 3.4% in 6 DVU and 23 DVU scores, respectively, for patients taking placebo (p < 0.001). A large treatment effect (Guyatt’s effect size ≥ 1.7) and high reliability was evident and comparable between 6 DVU and 23 DVU scoring methods.Conclusion.Treatment with low-dose IFX leads to a large treatment effect on spinal inflammation as measured by MRI. Scoring for inflammation of only the most severely affected regions of the spine by MRI is comparable to assessment of the entire spine.

Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis

2018 ◽  
Vol 45 (6) ◽  
pp. 771-778 ◽  
Author(s):  
Linda A. Bradbury ◽  
Kelly A. Hollis ◽  
Benoît Gautier ◽  
Sateesh Shankaranarayana ◽  
Philip C. Robinson ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ankylosing Spondylitis ◽  
Magnetic Resonance ◽  
Disease Activity ◽  
Treatment Response ◽  
Resonance Imaging ◽  
Diffusion Weighted ◽  
Asas Criteria ◽  
Adc Values ◽  
Group 1

Objective.We tested the discriminatory capacity of diffusion-weighted magnetic resonance imaging (DWI) and its potential as an objective measure of treatment response to tumor necrosis factor inhibition in ankylosing spondylitis (AS).Methods.Three cohorts were studied prospectively: (1) 18 AS patients with Bath Ankylosing Spondylitis Disease Activity Index > 4, and erythrocyte sedimentation rate > 25 and/or C-reactive protein > 10 meeting the modified New York criteria for AS; (2) 20 cases of nonradiographic axial spondyloarthritis (nr-axSpA) as defined by the Assessment of Spondyloarthritis international Society (ASAS) criteria; and (3) 20 non-AS patients with chronic low back pain, aged between 18 and 45 years, who did not meet the imaging arm of the ASAS criteria for axSpA. Group 1 patients were studied prior to and following adalimumab treatment. Patients were assessed by DWI and conventional magnetic resonance imaging (MRI), and standard nonimaging measures.Results.At baseline, in contrast to standard nonimaging measures, DWI apparent diffusion coefficient (ADC) values showed good discriminatory performance [area under the curve (AUC) > 80% for Group 1 or 2 compared with Group 3]. DWI ADC values were significantly lower posttreatment (0.45 ± 0.433 before, 0.154 ± 0.23 after, p = 0.0017), but had modest discriminating capacity comparing pre– and posttreatment measures (AUC = 68%). This performance was similar to the manual Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system.Conclusion.DWI is informative for diagnosis of AS and nr-axSpA, and has moderate utility in assessment of disease activity or treatment response, with performance similar to that of the SPARCC MRI score.

Vertebral Erosions Associated with Spinal Inflammation in Patients with Ankylosing Spondylitis Identified by Magnetic Resonance Imaging: Changes After 2 Years of Tumor Necrosis Factor Inhibitor Therapy

2013 ◽  
Vol 40 (11) ◽  
pp. 1891-1896 ◽  
Author(s):  
Xenofon Baraliakos ◽  
Joachim Listing ◽  
Hildrun Haibel ◽  
Joachim Sieper ◽  
Jurgen Braun
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ankylosing Spondylitis ◽  
Magnetic Resonance ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Inhibitor ◽  
Scoring Systems ◽  
Resonance Imaging ◽  
Necrosis Factor ◽  
Spinal Inflammation

Objective.Spinal inflammation and erosions have been described in magnetic resonance imaging (MRI) examinations of patients with ankylosing spondylitis (AS). MRI scoring systems have implemented these observations.Methods.MRI scans (T1 or short-tau inversion recovery) from tumor necrosis factor-α blocker (anti-TNF) trials with patients with active AS (n = 22) were analyzed at baseline and after 2 years based on vertebral units (VU). The analysis was based on the prevalence of spinal erosions in relation to inflammation (active erosions) or without it (inactive erosions) as an outcome measure on MRI and their course under anti-TNF therapy. The results of MRI scoring systems that include (ASspiMRI) or exclude (Berlin score) erosions were also compared.Results.At baseline, there were more VU with inflammation (33.7%) than with erosions irrespective of activity (10.6%). After 2 years, active erosions decreased to 3.7% while inflammation was seen in a total of 12% of VU — a reduction of 58.9% and 64.5%, respectively (both p < 0.02). The overall extent of erosions decreased from 10.6% at baseline to 5.6% at 2 years. At the patient level, 73% and 32% of patients showed active erosions (p = 0.002), while 100% and 64% of patients showed inflammation (p = 0.029) at baseline and 2 years, respectively. Both scoring systems showed similar improvement, independent of inclusion or exclusion of erosions.Conclusion.Inflammation with erosions was observed in the spine of most patients with AS but their contribution to changes observed upon anti-TNF therapy was small, indicating that erosions do not need to be included in quantitative scoring systems of inflammation. Spinal inflammation was still present after 2 years of anti-TNF therapy in two-thirds of patients.

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