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

作者：Karpitschka Martina^*; Godau Kellner Patrizia; Kellner Herbert; Horng Annie; Theisen Daniel; Glaser Christian; Brandlhuber Bernhard; Reiser Maximilian; Weckbach Sabine

来源：European Radiology, 2013, 23(7): 1773-1784.

DOI：10.1007/s00330-013-2794-1

• Spondylitis, ankylosing
• Magnetic resonance imaging
• Whole body imaging
• Anti-inflammatory agents
• Gadolinium

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.
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.
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.
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.
aEuro cent Multifocal musculoskeletal inflammation in AS is effectively treated by anti-TNF therapy.
aEuro cent Inflammatory lesions can be assessed by clinical examination and whole-body MRI.
aEuro cent AS activity significantly decreased under therapy as shown by WBMRI/clinical examination.
aEuro cent WBMRI detected more inflammatory lesions than clinical examination alone.
aEuro cent WBMRI improves detection of inflammatory changes and may help evaluation of therapy.

• 出版日期2013-7