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Magnetic resonance imaging of the spine and the sacroiliac joints in ankylosing spondylitis and undifferentiated spondyloarthritis during treatment with etanercept
  1. M Rudwaleit1,*,
  2. X Baraliakos2,*,
  3. J Listing3,
  4. J Brandt1,
  5. J Sieper1,
  6. J Braun2
  1. 1Rheumatology, Charité Campus Benjamin Franklin, Berlin, Germany
  2. 2Rheumazentrum-Ruhrgebiet, Herne, Germany
  3. 3German Rheumatism Research Centre, Berlin, Germany
  1. Correspondence to:
    Professor J Braun
    Rheumazentrum Ruhrgebiet, Landgrafenstr15, 44652 Herne, Germany; J.BraunRheumazentrum-Ruhrgebiet.de

Abstract

Objective: To assess the changes in inflammatory lesions of the spine and the sacroiliac (SI) joints as detected by magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (uSpA) with predominant axial symptoms during treatment with etanercept.

Methods: MRI of the spine and/or the SI joints of patients with active AS or axial uSpA was performed at baseline (TP0, n = 25), after 6 weeks (TP1, n = 20), and after 24 weeks of continuous treatment with etanercept (TP2, n = 12). T1 weighted spin echo pre -(T1), post-gadolinium (T1/Gd-DTPA) and short tau inversion recovery (STIR) MRI sequences were used to assess chronic and active spinal lesions using the scoring system ASspiMRI. Active and chronic SI lesions were assessed using a simple scoring system.

Results: By use of the definite STIR sequence, significant regression of spinal inflammation was already seen already after 6 weeks in the patients treated with etanercept (mean (SD) 11.2 (13.8) at TP0 v 6.8 (7.9) at TP1; p = 0.023) but not in patients treated with placebo. Continuous treatment with etanercept for 24 weeks reduced active spinal changes by 69% (p = 0.012). T1/Gd-DTPA sequences gave similar results. There was only a trend for a decrease of active inflammatory lesions of the SI joints.

Conclusions: Etanercept treatment in patients with active AS and uSpA leads to regression of active inflammatory lesions of the spine as depicted by MRI. The potential role of etanercept on deceleration of chronic spinal changes needs further study.

  • AS, ankylosing spondylitis
  • Gd-DTPA, gadolinium-diethylenetriamine-pentaacetic acid
  • MRI, magnetic resonance imaging
  • SI, sacroiliac
  • SpA, spondyloarthritides
  • STIR, short tau inversion recovery
  • TNF, tumour necrosis factor
  • uSpA, undifferentiated spondyloarthritis
  • ankylosing spondylitis
  • undifferentiated spondyloarthritis
  • etanercept
  • magnetic resonance imaging
  • ASspiMRI score
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Supplementary materials

  • There is an error in the legend of figure 2 of this article. The legend should read:

    Improvement of inflammatory spinal lesions in a patient with ankylosing spondylitis in the T1/Gd-DTPA MRI sequence before (A) and after (B) treatment with etanercept. The hyperintensity of the signal in the vertebra is no more detectable after 6 weeks of therapy with etanercept.

    Footnotes

    • * The first two authors contributed equally to this paper.

    • Published Online First 18 March 2005

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    • Correction
      BMJ Publishing Group Ltd and European League Against Rheumatism