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THU0332 Does Tnfα-Inhibition Influence the Progression of Degenerative Changes in the Lumbar Spine in Patients with Axial Spondylartritis (AX-SPA)?
  1. A. Keller1,
  2. I.J. Soerensen1,
  3. M. Ostergaard2,
  4. O.R. Madsen3,
  5. K.H. Asmussen4,
  6. J. Møller5,
  7. S.J. Pedersen1,
  8. G.B. Kollerup4,
  9. G.M. Thamsborg1
  1. 1Center for Rheumatology and Spine Diseases
  2. 2Center for Reumatology and Spine diseases, Glostrup Hospital, Glostrup
  3. 3Center for Rheumatology, Gentofte Hospital, Gentofte
  4. 4Center for Rheumatology, Frederiksberg Hospital
  5. 5Center for Radiology, Herlev Hospital, Copenhagen, Denmark


Background Tumor necrosis factor alpha (TNFα) have been identified as possible causes of Non-specific low back pain (LBP). This raises question of the influence of TNFα-inhibition at the development of degenerative changes as seen on magnetic resonance imaging (MRI).

Objectives The aim of this report was to assess the degree of degenerative changes in ax-SpA patients before and after 3 and 5 years treatment with TNFα-inhibitors.

Methods Forty ax-SpA patients (mean age 40.7 yrs (SD 10.8), 80% males, 120 discs), with sacroiliitis on MRI, a BASDAI of >30 mm and clinical indication for TNFα inhibitor therapy. MRI of the lumbar spine were obtained before initiation of TNFα inhibitor therapy (baseline), and after 3 and 5 years follow-up. The MRI-scans were evaluated for degenerative changes. The findings were reported as “present” or “not present” and at follow-up as “unchanged”, “deteriorated” or “improved”. The results were compared with available data from healthy controls and non-specific LBP.

Results At baseline 16 patients (40%) had a normal MRI, 22 (55%) decreased signal, 14 (35%) height reduction, 9 (23%) disc herniation, 2 (5%) Modic Type 1, 1 (3%) Modic Type 2, 3 (7%) Schmorl's node, 3 (7%) HIZ. Among 120 discs in total, 26 (22%) had decreased signal, 17 (14%) height reduction, 12 (10%) disc herniation, 2 (2%) Modic Type 1, 1 (1%) Modic Type 2, 5 (4%) Schmorl's node, and 3 (3%) HIZ.

At 3 years follow-up, development of the following new degenerative changes was noted: 7 discs (6.0%) showed decreased signal and 3 (3%) height reduction, disc herniation, Modic type 1 and Schmorl's nodes. Corresponding numbers from 3 to 5 years' follow-up were: 3 disc (3.6%) decreased signal, 2 (1.7) Modic Type 1 and 1 (1.0%) Schmorls nodes. There were improvement in 4 (3%) with respect to disc herniation, Modic type 1 and HIZ.

Conclusions The frequency of degeneration at baseline was comparable to the general population and patients with non-specific LBP, 16 - 50% [1.2]. The discs undergo morphological and cellular changes with age. However, in this study the progression and development of decreased signal, disc herniation and Modic type 1 were less pronounced than expected (14 - 42% progression in 4 years have been reported in non-specific LBP patients). [3] Surprisingly, there was a small improvement of the degeneration of the discs.

Conclusion The study suggest that the included patients with ax-SpA treated with TNFα-inhibition seemed to develop less degeneration in the lower lumbar spine over 5 years than expected from previous data from healthy persons and patients with LBP.


  1. Keller, A., et al., Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain? Eur Spine J, 2012. 21(3): p. 418-24.

  2. Cheung, K.M., et al., Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine (Phila Pa 1976), 2009. 34(9): p. 934-40.

  3. Kjaer, P., et al., Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine (Phila Pa 1976), 2005. 30(10): p. 1173-80.

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.5214

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