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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 …
Contributors GPRC devised the study, wrote protocol, made submissions to ethics and MHRA and was acting CI. He wrote the paper with AG. He submitted to the journal. JSHG was official CI. PO'C and AG reported the MRIs. PWB and SJG were local radiologists reporting baseline scans for recruitment purposes. SB and AG helped recruit patients and run (as consecutive PIs) the study at one centre.
Funding The study was made possible by an unrestricted grant awarded to Dr Clunie by Novartis. Novartis had no part in the study design or the collection, analysis or interpretation of the data nor in the writing of the report or in the decision to submit the paper for publication.
Competing interests None.
Ethics approval Cambridgeshire 4 Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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