THU0353 Efficacy of Anti TNF Alpha Therapy in Early Axial Spondyloarthritis is Similar Regardless the Presence of Objective Signs of Inflammation or Structural Damage of the Sacroiliac Joints. Data From the Desir Cohort.

2013 ◽  
Vol 72 (Suppl 3) ◽  
pp. A284.1-A284
Author(s):  
A. Moltó ◽  
S. Paternotte ◽  
P. Claudepierre ◽  
M. Dougados
Keyword(s):  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Tnf Alpha ◽  
Sacroiliac Joints ◽  
Alpha Therapy

Axial Spondyloarthritis and New Bone Formation

2021 ◽  
Vol 30 (04) ◽  
pp. 311-318
Author(s):  
Uta Syrbe
Keyword(s):  
Bone Formation ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Clinical Symptoms ◽  
Research Work ◽  
New Bone Formation ◽  
Sacroiliac Joints ◽  
Spine Mobility ◽  
Vertebral Bodies ◽  
Inflammatory Changes

AbstractAxial spondyloarthritis is an inflammatory disease of the axial skeleton. Its pathogenesis is only partly understood. At the beginning, there are inflammatory changes in the sacroiliac joints which are followed by inflammation in vertebral bodies and in facet joints. Low back pain occurring in the morning hours is the dominant clinical symptom. In the early phase, inflammatory changes are detectably by MRI. Inflammation promotes a process of joint remodelling in the sacroiliac joints which leads to erosions, sclerosis and bony bridging, i. e. ankylosis, which are detectable by X-ray. In the spine, vertical osteophytes developing at sites of previous inflammation connect vertebral bodies as syndesmophytes. Additional ossification of longitudinal ligaments contributes to the so-called bamboo spine. Ossification of the spine promotes fixation of a severe kyphosis of the thoracic spine which strongly impairs spine mobility and quality of life. High disease activity seems a prominent risk factor for development of structural damage. However, although NSAIDs improve clinical symptoms, they do not reduce new bone formation. In contrast, TNFα and IL-17 inhibitors seem to retard new bone formation apart from their clinical efficacy. Research work of the last years identified immunological pathways of inflammation. However, the trigger and cellular components of the immune reaction in the bone marrow are still poorly defined. Osteoclasts are involved in the destruction of the subchondral bone, while osteoblasts facilitate new bone formation and cartilage ossification. This review gives an overview about diagnostics and therapy of axSpA and about risk factors for the development of structural damage. Concepts about the immune pathogenesis and joint remodeling in AS are given under recognition of genetic and histopathological studies.

Imaging in axial spondyloarthritis

2016 ◽  
Author(s):  
Stefan Siebert ◽  
Sengupta Raj ◽  
Alexander Tsoukas
Keyword(s):  
New York ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Imaging Modalities ◽  
X Rays ◽  
Mri Imaging ◽  
Sacroiliac Joints ◽  
X Ray ◽  
X Ray Imaging ◽  
Imaging Results

Imaging has always been a key component in the diagnosis of ankylosing spondylitis as part of the modified New York criteria. With the increased availability of MRI and the development of the ASAS axial spondyloarthritis (axSpA) criteria, there has been a shift from x-ray imaging of structural damage to MRI imaging of inflammation. This information can help in both the diagnosis of axSpA and in guiding treatment decisions in patients with this diagnosis. However, imaging results must be evaluated in the context of the clinical picture and should not be acted on in isolation. Here we review the key imaging modalities used in axSpA, with the main focus on x-rays and MRI of the sacroiliac joints, spine, and peripheral structures. Advances in technology are also likely to lead to the development of even better imaging modalities for axSpA in future.

What are axial spondyloarthritis and ankylosing spondylitis?

2016 ◽  
Author(s):  
Stefan Siebert ◽  
Sengupta Raj ◽  
Alexander Tsoukas
Keyword(s):  
Ankylosing Spondylitis ◽  
Inflammatory Arthritis ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Negative Impact ◽  
Sacroiliac Joints ◽  
Chronic Inflammatory Arthritis ◽  
The Past ◽  
Assessment And Treatment

Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting mainly the sacroiliac joints and spine, resulting in pain, stiffness, and reduced movement. AS has a major negative impact on patients’ quality of life. AS is part of a larger group of related spondyloarthritis (SpA) conditions and patients with AS often have extra-articular manifestations of these conditions. Over the past decade, there have been major advances in the understanding of the genetics and pathophysiology of the disease. Advances in imaging have allowed patients to be diagnosed without having to develop the radiographic structural damage that characterize AS, resulting in the concept of axial spondyloarthritis (axSpA). Together with the development of highly effective TNF inhibitors, these advances have transformed the management and outlook of patients with this condition. It is hoped that further advances in diagnosis, assessment and treatment of axSpA will lead to further progress in future.

Top-Ten Tips for Effective Imaging of Axial Spondyloarthritis

2019 ◽  
Vol 23 (04) ◽  
pp. 376-391
Author(s):  
Monique Reijnierse ◽  
Iris Eshed ◽  
Floris van Gaalen
Keyword(s):  
Early Diagnosis ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Human Leukocyte ◽  
Sacroiliac Joints ◽  
Leukocyte Antigen ◽  
Treatment Regimens ◽  
Current Review ◽  
Chronic Inflammatory Condition ◽  
New Treatment

AbstractAxial spondyloarthritis (axSpA) is a chronic inflammatory condition that encompasses ankylosing spondylitis as well as nonradiographic axSpA and can lead to chronic pain, structural damage, and disability. The disease is strongly associated with the presence of human leukocyte antigen-B27. Early diagnosis of axSpA is significant due to new treatment regimens leading to reduction of inflammation and potentially delaying disease progression. Imaging of the sacroiliac joints and the spine plays an important role in the early diagnosis of spondyloarthritis. In the current review, the top-ten tips for the effective imaging of axSpA are presented to help both radiologists and rheumatologists in using imaging properly and effectively in their clinical practice.

scholarly journals POS0940 THE IMPACT OF TUMOUR NECROSIS FACTOR-ALPHA INHIBITOR TREATMENT ON WNT SIGNALING INHIBITORS, NOGGIN AND CYTOKINE LEVELS IN AXIAL SPONDYLOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 733.1-733
Author(s):  
N. Atas ◽  
B. Çakir ◽  
F. Bakir ◽  
M. Uçar ◽  
H. Satiş ◽  
...  
Keyword(s):  
Wnt Signaling ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Tnf Alpha ◽  
Healthy Controls ◽  
Necrosis Factor Alpha ◽  
Factor Alpha ◽  
The Impact ◽  
Dickkopf 1 ◽  
Necrosis Factor

Background:Axial spondyloarthritis (axSpA) is a common chronic inflammatory disease of the axial skeleton. Some cytokines have important roles in initiation and progression of disease and are elevated in active disease. Additionally, Wnt signaling pathway inhibitors and noggin also appear to be involved in pathogenesis of ankylosing spondylitis. Anti-tumor necrosis factor-alpha (TNF) agents have dramatically improved the clinical outcome of axSpa; however, acceptable clinical improvement is not achieved in all patients and capacity of anti-TNF to slow or prevent structural damage still remains controversial.Objectives:To evaluate the effect of anti-TNF on inflammatory and noninflammatory milieu in patients with axSpA.Methods:In this prospective study we included 30 biologic treatment naive adult patients with axSpA and 30 healthy controls. All patients with high disease activity were treated with anti-TNF therapy for 6 months. Laboratory and clinical evaluation of all patients were performed at baseline and after 6 months of anti-TNF treatment. Following cytokines and wnt/BMP antagonists were measured; TNF-Alpha, COX-2, IL-6, IL-17, IL-22, IL-23, IL-33, dickkopf-1, sclerostin, noggin.Results:The mean age of patients with axSpA and healthy controls were 38.1±13.3 and 37.7±7.7 years, respectively (p>0.005). At baseline, the median (IQR) TNF-alpha was higher in axSpA patients when compared to healthy controls, 34.4 pg/ml (31.4-37.03) vs 18.1 pg/ml (12.1-28.4), (p<0.001), while the median (IQR) dickkopf-1 and sclerostin were lower in axSpA patients, 446.7 pg/ml (356.9-529.3) vs 1088.7 pg/ml (951.7-1244.4), (p<0.001) and 312.4 pg/ml (140.8-412.7) vs 412.3 pg/ml (295.4-512.8), (p<0.001), respectively. IL-17, IL-22, IL-33, dickkopf-1 and sclerostin increased with anti-TNF treatment (table 1).Conclusion:Elevation of some cytokines which are important in pathogenesis of axSpA and nonincrease in noggin with anti-TNF drugs may affect effectiveness of anti-TNF treatment.Table 1.Changes of cytokines, dickkopf-1, sclerostin and noggin with anti-TNF treatment.Pre-Anti-TNFPost-Anti-TNFP valueIL-645(39.1-68.8)47.6(27.3-61.1)0.750IL-1793.3 (85.1-104.8)102.1(86.6-114.6)0.026IL-22159,2 (151,9-178.4)183.5(156.3-304.6)0.033IL-2336.5 (26.1-52.9)41.3(28.4-55.5)0.658IL-33127.8 (106.6-186.1)147.06(128.5-213.4)0.016COX20.176 (0-0.374)0.202(0.051-1.151)0.469TNFalpha34.4(31.4-37.03)30.7(12.8-35.6)0.004Dickkopf-1446.7(356.9-529.3)881.3(663.1-972.2)<0.001Sclerostin312.4 (140.8-412.7)405.1(276.3-452.5)0.018Noggin48.3(17.04-153.9)31.2(11.3-103.7)0.264Disclosure of Interests:None declared

Significance of structural changes in the sacroiliac joints of patients with axial spondyloarthritis detected by MRI related to patients symptoms and functioning

2021 ◽  
pp. annrheumdis-2021-221406
Author(s):  
Juergen Braun ◽  
Uta Kiltz ◽  
Xenofon Baraliakos
Keyword(s):  
Bone Formation ◽  
Structural Damage ◽  
Structural Changes ◽  
Axial Spondyloarthritis ◽  
Conventional Radiography ◽  
Axial Skeleton ◽  
Interleukin 17 ◽  
New Bone Formation ◽  
Sacroiliac Joints ◽  
Magnetic Resonance Imaging Mri

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that manifests primarily in the axial skeleton, initially mostly in the sacroiliac joints (SIJ), usually later spreading to the spine. The disease is characterised by inflammation and new bone formation which are mainly assessed by conventional radiography (CR) and magnetic resonance imaging (MRI). Tumour necrosis factor inhibitors (TNFi) and interleukin-17 antagonists have been shown to be efficacious and efficient in patients with axSpA. This treatment seems to also inhibit structural damage, for example, retard radiographic progression. Indeed, a reduction of new bone formation in the spine, as assessed by CR, has been reported to occur after at least 2 years of therapy with TNFi. Recently, a reduction of erosions and ankylosis in the SIJ has also been observed in axSpA patients treated with etanercept and filgotinib. In this narrative review, we discuss the limited significance of such findings.

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