Artikel
Effects of anti-TNF-therapy on osteoblastic activity in ankylosing spondylitis – results from a prospective study using PET-MRI of SIJ and spine
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Autoren
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Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr Universität Bochum, Herne
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Styliani Tsiami
- Rheumazentrum Ruhrgebiet Herne, Ruhr Universität Bochum, Herne
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Christoph Rischpler
- Universitätsklinikum Essen, Klinik für Nuklearmedizin, Essen
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Nils-Martin Bruckmann
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf
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Wolfgang Fendler
- Universitätsklinikum Essen, Klinik für Nuklearmedizin, Essen
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Julian Kirchner
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf
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Ken Herrmann
- Universitätsklinikum Essen, Klinik für Nuklearmedizin, Essen
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Lino Morris Sawicki
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf
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Jürgen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr Universität Bochum, Herne
| Veröffentlicht: | 9. September 2020 |
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Gliederung
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Introduction: The clinical efficacy of tumor necrosis factor inhibitors (TNFi) in patients with axial spondyloarthritis (axSpA) is well established but its effect on new bone formation is still unclear. We aimed to assess the effect of TNFi on bone remodeling processes in the axial skeleton of r-axSpA patients using [18F]F/MRI prior (baseline, BL) and 4 months after (follow-up, FU) treatment.
Methods: Patients with clinically active r-axSpA (11 male, 5 female, mean age 38.6±12.0 years, all BASDAI>4, failure of NSAIDs, no previous biologics) prospectively underwent 3-Tesla and [18F]F-PET/MRI. Images of the SIJ and the whole spine were performed at BL and FU. Three readers (1 for [18F]F/MRI and 2 for conventional MRI) evaluated all images independently and blinded to timepoint allocation. Inflammation (bone marrow edema, BME), structural lesions (fat deposition (FD), sclerosis, erosions and ankylosis) and focal [18F]F uptake were recorded on the level of SIJ (SIJ-Q) and vertebral quadrants (V-Q).
Results: A total of 128 SIJ-Q and 920 VQs were analyzed. In the SIJs, 75 (58.6%), 120 (93.8%), 69 (53.9%), 99 (77.3%) and 16 (12.5%) SIJ-Q showed BME, FD, sclerosis, erosions and ankylosis, while 111 (86.7%) SIJ-Q showed focal [18F]F-uptake at BL. Association with increased [18F]F-uptake was found most frequently in SIJ-Q with BME (70/75 SIJ-Q, 93.3%), sclerosis (65/69 SIJ-Q, 94.2%) and FD (105/120 SIJ-Q, 87.5%). At FU, 37 SIJ-Q still showed BME (improvement by 50.7%), while almost no changes were observed in chronic lesions. In comparison, improvement of focal [18F]F-uptake was found in all lesion combinations, with improvement of focal [18F]F-lesions associated with BME by 62.9%, with sclerosis by 33.8% and with FD by 22.9% of SIJ-Q.
In the spine, only 41 (4.5%), 61 (6.6%), 14 (1.5%) V-Q showed BME, FD and sclerosis, respectively, while 77 V-Q (8.4%) showed focal [18F]F-uptake. An association to increased [18F]F-uptake was found most frequently with sclerosis (7/14 V-Q, 50%) and FD (25/61 V-Q, 41%). At FU, 12 V-Q still showed BME (improvement by 70.7%), while almost no changes were observed in the chronic lesions. The largest improvement was found in focal [18F]F-lesions associated with BME 81.8% and with FD by 22.9% of V-Q.
Conclusion: In this first prospective study on whole spine and SIJ, significant decrease of osteoblastic activity was observed after TNFi treatment. The effect was observed not only at sites with BME but also at sites with pre-existing chronic structural lesions. These data support a short-term effect of TNFi treatment on osteoblastic activity, while the long-term effects need to be further studied.
Disclosures: None declared
