|
Multifocal Inflammatory Lesions in
Ankylosing Spondylitis Patients Depicted by Whole Body MRI (WBMRI)
Improve by a One Year Therapy with Etanercept
Martina Karpitschka
1, Daniel Theisen1, Annie
Horng1, Christian Glaser1, Maximilian
Reiser1, Sabine Weckbach1 and Herbert
Kellner2, 1Munich, Germany,
2Centre for Inflammatory Joint Diseases, Munich,
Germany
Presentation Number:
1321
Background/Purpose: In ankylosing
spondylitis (AS) multifocal inflammatory manifestations of the
musculoskeletal system are common. Whole-body magnetic resonance
imaging (WBMRI) is known to detect widespread inflammatory lesions.
Anti-tumor necrosis factor (TNF) therapy is highly effective in AS,
however, expensive. Therefore, accurate assessment of therapy
response is of clinical relevance. The purpose of this study was to
evaluate WBMRI compared to clinical exam alone in patients during
etanercept therapy.
Method: 6 patients with
AS underwent a 12 months therapy with etanercept (Enbrel
® 50 mg / week). Patients were examined by an
established WBMRI protocol (1.5 T scanner, STIR and T1-w unenhanced
and contrast-enhanced sequences) at 3 different points of time (0,
12 and 52 weeks) after application of the first dose of etanercept.
WBMRI was evaluated in consensus by 2 experienced radiologists
(blinded to clinical exam) for inflammatory lesions (e.g.
spondylitis, sacroileitis, bursitis, enthesitis and synovitis). The
lesions were counted and graded on a grading system (severe,
moderate, mild, minimal). Simultaneously, clinical examination was
performed by an experienced rheumatologist, including collecting
data from BASDAI, BASFI and CRP. WBMRI and clinical scores were
correlated.
Result: During etanercept
therapy, symptomatic therapy with NSAID could significantly be
reduced, (3.0±0.4 down to 1.5±0.2 (50%, p<0.05). The clinical
examination scores showed significant improvement under therapy,
e.g. the BASDAI-index decreased from 5.6±0.7 (week 0) to 1.6±0.5 (weeks 12, p<0.05) and to
1.4±0.6 (week 52,
p<0.05). The patients’ estimation of AS activity at week 0 averaged
6.8±1.1, physician
assessment was 7.0+0.3 respectively. At week 12, the AS-activity
averaged 1.2±0.5 by
patients (p<0.05) and 2.0±0.3 (p<0.05) by the physician. The
amount of pain diminished during therapy from
7.2±0.7 (BASDAI, week 0)
to 1.3±1.0 (BASDAI, week
52).The morning stiffness significantly decreased from
72,0±18.0 (week 0) to
12.0±8.7 (week 52). In
addition, clinical values improved under therapy, e.g. CRP averaged
15.9±4.7 at week 0 and
declined to 2.1±21 at
week 52 (p=0.055). In WBMRI, the sum of all lesions showed a
significant decrease from week 0 (30.6±12.4) to week 12 (14.2±7.5), equivalent to a 59.2±13.8% reduction of lesions. Especially for
spondylitis anterior and sacroileitis, there was a significant
decline of inflammatory lesion, e.g. 9.5±2.6 in week 0 to 1.0±1.0 in week 52 for spondylitis anterior (reduction
about 92.7±7.3,
p<0.05) or 5.5±1.0 in week 0 to 0.0±0.0 in week 52 for sacroileitis (reduction of 100%,
p<0.05). WBMRI detected significantly more areas of
synovialitis and enthesitis than clinical examination
(p<0.05).
Conclusion: Under etanercept
therapy the activity of AS significanty decreased, which was proven
by clinical examination, CRP and quality of life questionnaires
(BASDAI) as well as by WBMRI. WB-MRI detected significantly more
inflammatory lesions than clinical exam alone. The results suggest
that WB-MRI improves the detection of inflammatory changes and the
assessment of their course under therapy.
|
依那西普治疗1年能改善AS患者全身MRI（WBMRI）证实的多灶性炎症损害
Martina Karpitschka , et al. ACR
2011. Present No: 1321
背景/目的:
强直性脊柱炎(AS)常见有骨骼肌肉系统的多灶性炎症。已知全身核磁共振成像(WBMRI) 可以检测广泛炎症损伤。抗肿瘤坏死因子(TNF)治疗AS非常有效,但价格昂贵。因此,正确地评估治疗反应是临床关注的问题。本研究旨在评价WBMRI与临床检测相比在依那西普治疗中的价值。
方法:纳入6例接受依那西普治疗12个月的患者(Enbrel®50mg/周)。按照WBMRI标准设置(1.5T扫描仪,STIR和T1-w平扫和增强序列)在患者接受第一剂伊纳西普后3个不同时间点（0，12和52周）进行检测。WBMRI由2位有经验的放射科医生（不了解临床资料)评估炎性病变(如脊柱炎、骶髂关节炎滑囊炎,和滑膜炎)。计算病灶数目并作分级评分(严重的,
中度的,轻度的,微小的)。同时,
由一位经验丰富的风湿病医生进行临床检查,包括收集BASDAI,BASFI和CRP数据。WBMRI和临床指标相关。
结果:
依那西普治疗期间,
非甾体类抗炎药的对症治疗显著减少(3.0±0.4下降到1.5±0.2(50%,p <
0.05)。临床检查积分明显改善,
BASDAI积分从5.6±0.7(0周) 下降到1.6±0.5(12周，p
< 0.05)和1.4±0.6(52周,p
< 0.05)。0周时，患者的疾病评估平均值6.8±1.1,医生的评估值7.0±0.3。在第12周,上述指数分别降为1.2±0.5
(p < 0.05)和2.0±0.3(p <
0.05)。治疗期间疼痛的程度从7.2±0.7
(BASDAI,0周)减少到1.3±1.0(BASDAI，52周)。晨僵时间从72.0±18.0(周0) 显著降低到12.0±8.7(52周)。此外,
临床指标也随之改善,例如CRP平均值从0周15.9±4.7下降为52周的2.1±21(p =
0.055)。WBMRI中,所有病灶总数从0周(30.6±12.4) 到12周(14.2±7.5) 明显减少,相当于减少了59.2±13.8%病灶。特别是脊柱炎前缘和骶髂关节炎,炎性损害减少明显，例如，脊柱前缘从0周9.5±2.6到52周0±1.0
(减少约92.7±7.3,p
< 0.05),骶髂关节炎从0周5.5±1.0到52周0.0±0.0
(降低了100%,p
< 0.05)。WBMRI所检测到的滑膜炎和附着点炎的范围要明显多于临床检查(p < 0.05)。
结论:依那西普治疗AS使活动度显著降低，这已经通过临床检查、CRP和生活质量问卷调查（BASDAI）以及WBMRI证实。WB-MRI比单独的临床检查能发现更多的炎症病灶。结果表明, WB-MRI能改善炎症变化的检测能力和治疗的评估效果。
|