Article
Functional status remains stable despite continuous radiographic spinal progression over ten years under anti-TNF therapy in patients with ankylosing spondylitis
Search Medline for
Authors
-
Denis Poddubnyy
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
-
Aleksandra Fedorova
- Charité Universitätsmedizin Berlin, Berlin
-
Joachim Listing
- Deutsches Rheuma-Forschungszentrum (DRFZ), Programmbereich Epidemiologie, Berlin
-
Hanna Dyck
- Deutsches Rheumaforschungszentrum (DRFZ), Berlin
-
Hildrun Haibel
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
-
Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne
-
Jürgen Braun
- Rheumazentrum Ruhrgebiet, Herne
-
Joachim Sieper
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
| Published: | September 1, 2015 |
|---|
Outline
Text
Introduction: Impaired function and spinal mobility in patients with ankylosing spondylitis (AS) can be caused by both spinal inflammation and new bone formation.
The aim of the study was to investigate the impact of long-term (up to 10 years) anti-TNF therapy on function and spinal mobility in relation to radiographic progression in the spine and to disease activiy in patients with AS.
Methods: Altogether 60 patients with AS from two long-term trials with TNF blockers (43 on infliximab and 17 on etanercept) were included in this completer analysis based on availability of spinal x-rays performed at baseline and at least at one following time-point (year 2, 4, 6, 8, 10) during the follow-up. Spinal radiographs (cervical and lumbar spine lateral views) were scored according to the mSASSS system by two readers (DP and AF). The functional status (BASFI), spinal mobility (BASMI) and disease activity (BASDAI) were assessed at all time-points.
Results: The dynamics of the mSASSS score, BASDAI, BASFI and BASMI over 10 years at the group level (data as observed) are presented in Figure 1 [Fig. 1]. After the BASFI had initially improved significantly in response to anti-TNF therapy in those patients who remained on the drug over time it remained remarkably stable at low levels over 10 years despite the observed increase of the mSASSS by 6 points in the same patients. Similarly, BASMI had improved after initiation of anti-TNF therapy and remained at the low level until year 10: baseline – 3.5, year 2 – 2.5, year 4 – 2.1, year 6 – 2.1, year 8 – 2.5, year 10 – 2.7. The BASDAI also remained stable at levels < 3 indicating good control of disease activity.
Conclusion: Functional status in patients with advanced AS remained stable during long-term anti-TNF therapy despite some radiographic progression. Under these conditions the BASFI course correlated strongly with BASDAI but not with the mSASSS. This might indicate that a good control of inflammation is able to overweight the negative effect of structural damage in the spine on the functional status in AS.
