Objective: To evaluate the role of MRI in predicting a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) improvement of at least 50% (BASDAI 50) upon anti-tumour necrosis factor (TNF) therapy of active ankylosing spondylitis (AS).
Methods: MRIs from patients with active AS who participated in randomised controlled trials were analysed with respect to presence and extent of active inflammatory lesions as detected in the spine (n = 46), sacroiliac (SI) joints (n = 42) and both sites (n = 26). Univariate and multivariate logistic regression analyses were applied to evaluate MRI and clinical data in predicting a BASDAI 50 response.
Results: The Berlin MRI spine score (odds ratio (OR) 1.16, 95% CI 1.02 to 1.33) and disease duration (OR 0.9, 95% CI 0.63 to 0.97) were statistically significant predictors of a BASDAI 50 response using regression analysis while there was only a trend for C-reactive protein (CRP). The likelihood ratio (LR) for achievement of BASDAI 50 was increased in patients with a Berlin MRI spine score ⩾11 (LR 6.7), disease duration <10 years (LR 4.2) and CRP ⩾40 mg/litre (LR 3.4). All patients with two or three of these predictors improved clinically (as assessed by BASDAI) by at least 45%. Disease duration >20 years, normal CRP and no active inflammatory lesion in the spine were highly predictive of not achieving BASDAI 50. A trend was only found for the MRI score of SI joints to be predictive.
Conclusions: Widespread inflammation in the spine as detected by MRI contributes to predicting a BASDAI 50 response in active patients with AS treated with anti-TNF agents.
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Funding: The two clinical trials featured in this study were conducted as investigator initiated trials with financial support of the Schering-Plough Corporation and Wyeth Pharmaceuticals, respectively. We further thank the German Ministry of Education and Research (BMBF) for financial support of our work in spondyloarthritis (grant FKZ 01GI9946).
Competing interests: None declared.