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Assessment of therapeutic response in ankylosing spondylitis patients undergoing anti-tumour necrosis factor therapy by whole-body magnetic resonance imaging

  • Magnetic Resonance
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Abstract

Objectives

Multifocal musculoskeletal inflammation is common in ankylosing spondylitis (AS) and is effectively treated by expensive anti-TNF (tumour necrosis factor) therapy. This study evaluated assessment of response by whole-body (WB) MRI compared with clinical assessment in AS patients during etanercept therapy.

Methods

Ten patients with AS underwent a 12-month therapy with etanercept. Clinical markers were monitored [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and C-reactive protein (CRP)] and patients underwent WBMRI (1.5 T, STIR and T1-weighted) at three different time points (0, 26 and 52 weeks). WBMRI was evaluated and correlated with clinical scores.

Results

The BASDAI index decreased under therapy from 5.5 ± 0.5 (week 0) to 1.7 ± 0.5 (week 52, P < 0.05). CRP declined from 15.7 ± 2.2 mg/dl (week 0) to 0.9 ± 0.9 mg/dl (week 52, P < 0.05). In WBMRI, the sum of all lesions showed a significant decrease from week 0 (38.9 ± 3.4) to week 52 (2.2 ± 0.9, 94.3 % reduction). WBMRI detected more areas of synovitis and enthesitis than clinical examination alone.

Conclusions

AS activity significantly decreased under etanercept therapy, which was proven by clinical examination and WBMRI. WBMRI detected more inflammatory lesions than clinical examination alone. The results suggest that WBMRI improves the detection of inflammatory changes and the assessment of their course under therapy.

Key Points

• Multifocal musculoskeletal inflammation in AS is effectively treated by anti-TNF therapy.

• Inflammatory lesions can be assessed by clinical examination and whole-body MRI.

• AS activity significantly decreased under therapy as shown by WBMRI/clinical examination.

• WBMRI detected more inflammatory lesions than clinical examination alone.

• WBMRI improves detection of inflammatory changes and may help evaluation of therapy.

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Abbreviations

AS:

Ankylosing spondylitis

anti-TNF:

Anti-tumour necrosis factor

ASAS:

Assessment in Spondyloarthritis International Society

BASDAI:

Bath Ankylosing Spondylitis Disease Activity Index

BASFI:

Bath Ankylosing Spondylitis Functional Index

BME:

Bone marrow oedema

CIL:

Corner inflammatory lesion

CRP:

C-reactive protein

ESR:

Erythrocyte sedimentation rate

ESSG:

European Spondyloarthropathy Study Group

FIL:

Facet joint inflammatory lesion

ICC:

Intraclass correlation coefficient

LIL:

Lateral inflammatory lesion

NIL:

Non-corner inflammatory lesion

NSAID:

Non-steroidal anti-inflammatory drugs

PIL:

Posterior element inflammatory lesion

WBMRI:

Whole-body magnetic resonance imaging

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Acknowledgements

As a specific source of funding for this study, we want to disclose an unrestricted fund from Pfizer GmbH Germany.

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Authors and Affiliations

  1. Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Marchionini Str. 15, 81377, Munich, Germany

    Martina Karpitschka, Annie Horng, Daniel Theisen, Bernhard Brandlhuber, Maximilian Reiser & Sabine Weckbach

  2. Praxis für Rheumatologie, Romanstr. 9, 80639, Munich, Germany

    Patrizia Godau-Kellner & Herbert Kellner

  3. Radiologisches Zentrum München-Pasing, Pippinger Str. 25, 81245, Munich, Germany

    Christian Glaser

  4. Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Sabine Weckbach

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  1. Martina Karpitschka
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  2. Patrizia Godau-Kellner
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  4. Annie Horng
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Correspondence to Martina Karpitschka.

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Karpitschka, M., Godau-Kellner, P., Kellner, H. et al. Assessment of therapeutic response in ankylosing spondylitis patients undergoing anti-tumour necrosis factor therapy by whole-body magnetic resonance imaging. Eur Radiol 23, 1773–1784 (2013). https://doi.org/10.1007/s00330-013-2794-1

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  • DOI: https://doi.org/10.1007/s00330-013-2794-1

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