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Spinal lesions in ankylosing spondylitis (AS) include osteitis and spondylodiscitis—bone lesions characterised by high signal on T2w fat-suppressed or STIR magnetic resonance (MR) imaging.1 Pamidronate treats osteitis and improves spinal symptoms in non-steroidal anti-inflammatory drug (NSAID)-refractory AS,2 but treatment gains are modest. Zoledronic acid (Aclasta/Reclast; ZA) is more ‘potent’ than pamidronate,3 but it is unknown whether ZA improves osteitis in AS. We evaluated whether ZA reduces osteitis lesions in AS using an MR index of spinal osteitis4 previously shown to correlate with, and be responsive to treatment of, AS disease activity measures.5
Patients with AS (modified New York criteria,6 >18 years old, Bath AS Disease Activity Index (BASDAI) ≥4.15, anti-tumour necrosis factor α (anti-TNFα)-naive) were recruited based on having osteitis in two or more discovertebral units (DVUs; SPARCC definition …
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