Magnetic Resonance Imaging of the Sacroiliac Joints in Ankylosing Spondilitis Before and After Therapy with Anti-Tumor Necrosis Factor Alpha

Year 2012, Volume: 13 Issue: 3, 7 - 11, 01.12.2012

Şenol Kobak Fahrettin Oksel Vedat İnal Yasemin Kabasakal

Abstract

OBJECTIVE: The goal of this study is to assess the changes in the sacroiliac joints (Sİ) by magnetic resonance imaging (MRI) in a 24-week follow-up period and to determine the efficacy and safety of anti-TNF-α therapies for refractory AS. MATERIALS and METHODS: Twenty-seven patients who met the modified New York criteria for AS were enrolled in this study. Activity of sacroiliitis was determined by Gd-MRI scan before and after anti-TNF-α treatment. Eight patients received infliximab at a dose of 4mg/kg by intravenous infusion over 2 hours at every 4 week. Other 19 patients were treated with 25mg subcutaneous etanercept twice weekly. Total observational period was 24 weeks. The clinical and laboratory variables included: Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), pain on a visual analog scale, Schober's index, chest expansion, C-reactive protein(CRP), erythrocyte sedimentation rate (ESR). RESULTS: Most patients responded well to treatment of anti-TNF-α antagonists. At 24 weeks, there was an improvement in all of the following measures. Imaging studies showed decreased inflammation of the SI joints after 24 weeks of treatment with anti-TNF-α therapies in only 3 patients. CONCLUSION: The anti-TNF-α therapy was safe and effective in treating patients with active AS during 24-week study period. The BASDAI, BASFI, VAS of pain were decreased well. But we could not determine any regression of acute inflammatory changes of the SI joints as depicted by MRI.

Keywords

Ankylosing spondylitis, anti-TNF-á therapies, magnetic resonance imaging, sacroiliac joints

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