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Abstract
Background The introduction of anti-tumour necrosis factor-α (anti-TNF-α) has significantly altered the treatment landscape of inflammatory arthritis. It has proven to be an excellent treatment option for reducing Ankylosing spondylitis(AS) symptoms. The impact of anti-TNF-α on the radiographic progression of AS has been difficult to characterise, in part because of the relatively slow rate of radiographic change in AS and the hurdles it imposes on longer-term placebo-controlled trials. Despite symptomatic improvement, conclusions concerning effect of anti-TNF-α treatment on radiographic progression in patients with AS remain inconsistent. Furthermore, while many studies have reported the impact of anti-TNF-α on radiographic progression, limited data are available on the relationship between treatment agents and sagittal balance in AS.
Objectives Limited data are available on the relationship between treatment agents and sagittal balance in AS. We investigated radiological features related to treatment agents and compared sagittal balance between patients treated with anti-tumour necrosis factor-α (anti-TNF- α) or non-steroidal anti-inflammatory drugs (NSAIDs) and sulfasalazine.
Methods We prospectively enrolled 133 consecutive AS patients. Patients were eligible for the trial if they were under medical treatment with the same treatment agents for at least 1 year. All patients were treated initially with NSAIDs and sulfasalazine. Sixty-nine patients were achieved an excellent pain control outcome with these agents (Group A). Sixty-four patients who complained of intractable low back pain were switched to anti-TNF-α treatment (Group B). Twelve radiographic parameters were measured. Clinical outcome was assessed with the Bath AS Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). All parameters were measured at enrolment, upon changing treatment agents, and every 6 months during follow-up.
Results Mean ESR, CRP, BASDAI, and thoracic kyphosis at baseline were significantly higher in group B. After treatment, group B had significantly higher lumbar lordosis and significantly better clinical outcomes. Correlation analysis revealed significant relationships between radiologic parameters and BASDAI. On multiple regression analysis, lumbar lordosis was a significant predictor of BASDAI.
Conclusions This study demonstrated a clear association between treatment agents and radiologic parameters in AS. Anti-TNF-α treatment improved lumbar lordosis and slowed thoracic kyphotic progression with improvement of clinical outcomes. Lumbar lordosis was a significant predictor of clinical outcome in AS patients treated with anti-TNF-α
Disclosure of Interest None declared