Article Text

AB0852 Early improvement in enthesis by us predict later favorable response in TNF inhibotors with SPA
  1. K. Kume1,
  2. K. Amano1,
  3. S. Yamada1,
  4. N. Kuwaba2
  1. 1Rheumatology, Hiroshima Clinic
  2. 2Medical Research, Sanki Clinical Link, Hiroshima, Japan


Background Lower limbs enthesis by ultrasound (US) detects inflammatory activity in patients with spondyloarthritis (SpA) and is a diagnostic tool of early SpA.

Objectives The present objective was to follow SpA patients starting anti-TNF inhibitors with US and clinical assessments to explore whether any variable could predict a major decrease in disease activity after 12 weeks.

Methods This study is prospective and blinded study. Patients with SpA starting anti-TNF inhibitors were consecutively included and examined at baseline and, after 1 and 12 weeks with standardized bilateral ultrasound of six entheses (Madrid sonography enthesitis index (MASEI)). In addition, the patients were assessed clinically with ASDAS, assessor global VAS (study nurse), ESR and CRP. Patients with ASDAS clinical important improvement at the 12 weeks examination was defined as responders. The results of US score (MASEI), clinical and laboratory assessments at baseline and after 1 week were explored by Mann-Whitney tests to examine for associations with the responders.

Results A total of 21 patients were included (mean (SD) age 62.3 (21.2) years, disease duration12.2 (6) years, and 35% women, with 76% using infliximab and 24% adalimumab).A total of 67% of the patients were defined as ASDAS responders, and they had significantly lower US score (MASEI) (p=0.03), assessor global VAS (study nurse) (p=0.02), and CRP (p=0.02)at the 12 weeks examination.

Baseline US score (MASEI), ASDAS, assessor global VAS, ESR or CRP did not separate between responders and non-responders.

At 1 week examination the only variable differing between responders and non-responders was the US score (MASEI), with a significant reduction in US score (MASEI) in the responders versus non-responders 12.6 (5.4) versus 2.3(3.3) (p=0.03).

Conclusions US enthesis images at 1 week after TNF inhibitors are useful to identify responders early.

  1. Alcalde M, Acebes JC, Cruz M, et al. A sonographic enthesitic index of lower limbs is a valuable tool in the assessment of ankylosing spondylitis. Ann Rheum Dis 2007; 66:1015-19.

  2. Machado P, Landewé R, Lie E, Kvien TK et al. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis. 2011; 70:47-53

Disclosure of Interest None Declared

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