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THU0263 Development of chronic inflammatory changes on whole body magnetic resonance imaging in patients with early axial spondyloarthritis after two years of continuous treatment with etanercept – 2 year data of the esther trial
  1. I.-H. Song1,
  2. K.-G. Hermann2,
  3. H. Haibel1,
  4. C. Althoff2,
  5. D. Poddubnyy1,
  6. J. Listing3,
  7. A. Weiss3,
  8. E. Lange4,
  9. B. Freundlich5,
  10. M. Rudwaleit1,6,
  11. J. Sieper1
  1. 1Medical Clinic I/Rheumatology, Charite Campus Benjamin-Franklin
  2. 2Radiology, Charité Campus Mitte
  3. 3Statistics, German Rheumatism Research Center
  4. 4Pfizer, Berlin, Germany
  5. 5Rheumatology, University of Pennsylvania, Philadelphia, United States
  6. 6Private Practice, Endokrinologikum, Berlin, Germany

Abstract

Objectives In axial spondyloarthritis (SpA) patients (disease duration of <5 years) with active inflammation on whole-body magnetic resonance imaging (wb-MRI) in the spine and/or sacroiliac joints (SI-joints) at baseline (BL) [1] we assessed the development of chronic lesions over an etanercept (ETA) treatment period of 2 years.

Methods Wb-MRIs of 65 patients treated with ETA (n=35) or SSZ (n=30) over 1 year [1,2] and with ETA for the second year were scored for active inflammation, fatty lesions and erosions in the 23 vertebral units (VUs) of the spine and in the 8 SI-joint quadrants by two blinded readers. Here, we analysed chronic lesions (fatty lesions, erosions) in the subgroup treated with ETA continuously over 2 years.

Results In total 168 SI-joint quadrants and 437 VUs could be analysed. The mean scores for active inflammation decreased significantly for both the SI-joints and the spine between BL and W(eek) 48, while between W48 and W108 there was no further changes (table 1). In this new reading we could confirm [1] the significant increase of the mean fatty lesion scores between BL and W48 for both the SI-joints and the spine (p<0.05). However, there was no change in the fatty lesion score in the SI-joints between year 1 and 2 and even a decrease in the spine over this period (table 1). Among 101 SI-joint quadrants with fatty lesions at W48 no fatty lesions disappeared between W48 and W108. At the same time, among 67 quadrants without fatty lesions at BL between W48 and W108 no new fatty lesions developed. On the spine level, among 27 VUs with fatty lesions at W48, 48.2% (13/27) fatty lesions disappeared between W48 and W108. At the same time among 410 VUs without fatty lesions, only 1 new fatty lesion developed between W48 and 108. Regarding erosions among the 7 spinal VUs with erosions at W48 none of these disappeared while among the 98.4% (433/437) VUs without erosions at W48 no new erosions developed. Similarly, among 79 SI-joint quadrants with erosions no erosions disappeared, and among 85 quadrants without erosions no new erosions developed.

Table 1

Conclusions During continuous treatment with ETA over 2 years in patients with early axial SpA no new chronic lesions (fatty lesions and/or erosions) appeared in the SI-joints or the spine between year 1 and 2. It remains to be determined whether the disappearance of fatty lesions in some of the spinal VU indicates real improvement or just transformation of these lesions into new bone formation.

  1. Song I.-H. et al. Ann Rheum Dis. 2011;70(4):590-6.

  2. Song I.-H. et al. Ann Rheum Dis. 2011;70(7):1257-63.

Disclosure of Interest I.-H. Song Speakers Bureau: Pfizer/Wyeth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals: consulting fees or other remuneration. K.-G. Hermann: None Declared, H. Haibel Speakers Bureau: Pfizer/Wyeth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals: consulting fees or other remuneration. C. Althoff: None Declared, D. Poddubnyy Speakers Bureau: Pfizer/Wyeth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals: consulting fees or other remuneration. J. Listing: None Declared, A. Weiss: None Declared, E. Lange Employee of: Pfizer Germany, B. Freundlich Employee of: former employee from Pfizer/Wyeth, M. Rudwaleit Speakers Bureau: Pfizer/Wyeth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals, UCB: consulting fees or other remuneration. J. Sieper Grant/Research support from: Study supported with an unrestricted grant from Pfizer/Wyeth. Speakers Bureau: Pfizer/Wyeth Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals, UCB: consulting fees or other remuneration.

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