Aim To investigate the relationship between active inflammatory lesions on whole-body MRI (wb-MRI) and new development of chronic lesions on T1 MRI in patients with early axial spondyloarthritis (SpA) treated either with etanercept (ETA) or sulfasalazine (SSZ).
Methods Wb-MRIs of 65 patients treated either with ETA (n=35) or SSZ (n=30) over 1 year were scored for active inflammation, fatty lesions, erosions and ankylosis in the 23 vertebral units (VUs) of the spine and in the sacroiliac joints (SI joints). Scoring was performed by two blinded radiologists.
Results If there was no previous inflammation in the bone no new fatty lesions occurred in SI joint quadrants and only a few (0.6%) in spine VUs. There was a significant relationship between disappearance of inflammation and the appearance of fatty lesions: if baseline inflammation resolved fatty lesions occurred in 10.5% of SI joint quadrants and 17.9% of VUs. If inflammation did not resolve over 1 year, fatty lesions occurred less frequently: 2.4% (SI joint quadrants) and 7.2% (VUs). There was a significantly higher increase of the mean fatty lesion score between baseline and week 48 in the ETA (4.0 vs 4.8 for the SI joints and 1.9 vs 2.7 for the spine) compared to the SSZ (3.0 vs 3.2 for the SI joints and 1.1 vs 1.2 for the spine, respectively) group (p=0.001 and p=0.020 for the differences). No significant changes in the erosion or ankylosis score were observed in any of the two groups during this time.
Conclusions These data indicate that there is a close interaction between inflammation, tumour necrosis factor blockade and the development of fatty lesions in subchondral bone marrow of patients with axial SpA.
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Funding This study was supported by an unrestricted grant from Wyeth/Pfizer.
Competing interests I-HS: consulting fees or other remuneration from Wyeth/Pfizer Pharmaceuticals, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals. KGH: None. HH: consulting fees or other remuneration from Wyeth/Pfizer, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals. CA: None. DP: consulting fees or other remuneration from Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals. JL: None. AW: None. BF: former employee of Pfizer/Wyeth. MR: consulting fees or other remuneration from Wyeth/Pfizer, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals, UCB. JS: consulting fees or other remuneration from Wyeth/Pfizer, Merck Sharp Dohme/Schering Plough, Abbott Immunology Pharmaceuticals, UCB.
Ethics approval This study was conducted with the approval of the Local ethics committee: Landesamt für Gesundheit und Soziales, Geschaeftsstelle der Ethik- Kommission des Landes Berlin, Saechsische Straße 28, 10707 Berlin, Germany.
Provenance and peer review Not commissioned; externally peer reviewed.
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