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Radiologic parameters of ankylosing spondylitis patients treated with anti-TNF-α versus nonsteroidal anti-inflammatory drugs and sulfasalazine

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Abstract

Purpose

Limited data are available on the relationship between treatment agents and sagittal balance in ankylosing spondylitis (AS). We investigated radiological features related to treatment agents and compared sagittal balance between patients treated with anti-tumor necrosis factor-α (anti-TNF-α) and those treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and sulfasalazine (SSZ).

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 SSZ. Sixty-nine patients achieved an excellent pain control outcome with these agents (group A). Sixty-four patients who reported 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

The mean ESR, CRP, BASDAI, and thoracic kyphosis at baseline were significantly higher in group B. After treatment, group B had significantly higher lumbar lordosis (LL) and significantly better clinical outcomes. Correlation analysis revealed significant relationships between radiologic parameters and BASDAI. On multiple regression analysis, LL 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 LL with improvement in clinical outcomes. Lumbar lordosis was a significant predictor of clinical outcome in AS patients treated with anti-TNF-α.

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References

  1. Zochling J, van der Heijde D, Burgos-Vargas R, Collantes E, Davis JC Jr, Dijkmans B, Dougados M, Geher P, Inman RD, Khan MA, Kvien TK, Leirisalo-Repo M, Olivieri I, Pavelka K, Sieper J, Stucki G, Sturrock RD, van der Linden S, Wendling D, Bohm H, van Royen BJ, Braun J (2006) ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 65:442–452

    Article  CAS  PubMed  Google Scholar 

  2. Edmunds L, Elswood J, Kennedy LG, Calin A (1991) Primary ankylosing spondylitis, psoriatic and enteropathic spondyloarthropathy: a controlled analysis. J Rheumatol 18:696–698

    CAS  PubMed  Google Scholar 

  3. Braun J, Sieper J (2007) Ankylosing spondylitis. Lancet 369:1379–1390

    Article  PubMed  Google Scholar 

  4. White AA 3rd, Panjabi MM, Thomas CL (1977) The clinical biomechanics of kyphotic deformities. Clin Orthop Relat Res 128:8–17

    Google Scholar 

  5. Debarge R, Demey G, Roussouly P (2010) Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J 19:65–70

    Article  PubMed  Google Scholar 

  6. Inman RD, Davis JC Jr, Heijde D, Diekman L, Sieper J, Kim SI, Mack M, Han J, Visvanathan S, Xu Z, Hsu B, Beutler A, Braun J (2008) Efficacy and safety of golimumab in patients with ankylosing spondylitis: results of a randomized, double-blind, placebo-controlled, phase III trial. Arthritis Rheum 58:3402–3412

    Article  CAS  PubMed  Google Scholar 

  7. van der Heijde D, Dijkmans B, Geusens P, Sieper J, DeWoody K, Williamson P, Braun J (2005) Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthritis Rheum 52:582–591

    Article  CAS  PubMed  Google Scholar 

  8. Braun J, van der Horst-Bruinsma IE, Huang F, Burgos-Vargas R, Vlahos B, Koenig AS, Freundlich B (2011) Clinical efficacy and safety of etanercept versus sulfasalazine in patients with ankylosing spondylitis: a randomized, double-blind trial. Arthritis Rheum 63:1543–1551

    Article  CAS  PubMed  Google Scholar 

  9. Braun J, Baraliakos X, Hermann KG, Deodhar A, van der Heijde D, Inman R, Beutler A, Zhou Y, Xu S, Hsu B (2014) The effect of two golimumab doses on radiographic progression in ankylosing spondylitis: results through 4 years of the GO-RAISE trial. Ann Rheum Dis 73:1107–1113

    Article  CAS  PubMed  Google Scholar 

  10. Haroon N, Inman RD, Learch TJ, Weisman MH, Lee M, Rahbar MH, Ward MM, Reveille JD, Gensler LS (2013) The impact of tumor necrosis factor alpha inhibitors on radiographic progression in ankylosing spondylitis. Arthritis Rheum 65:2645–2654

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Maas F, Spoorenberg A, Brouwer E, Bos R, Efde M, Chaudhry RN, Veeger NJ, van Ooijen PM, Wolf R, Bootsma H, van der Veer E, Arends S (2015) Spinal radiographic progression in patients with ankylosing spondylitis treated with TNF-alpha blocking therapy: a prospective longitudinal observational cohort study. PLoS ONE 10:e0122693

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. van der Heijde D, Salonen D, Weissman BN, Landewe R, Maksymowych WP, Kupper H, Ballal S, Gibson E, Wong R (2009) Assessment of radiographic progression in the spines of patients with ankylosing spondylitis treated with adalimumab for up to 2 years. Arthritis Res Ther 11(4):R127

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368

    Article  PubMed  Google Scholar 

  14. Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, Braun J, Chou CT, Collantes-Estevez E, Dougados M, Huang F, Gu J, Khan MA, Kirazli Y, Maksymowych WP, Mielants H, Sorensen IJ, Ozgocmen S, Roussou E, Valle-Onate R, Weber U, Wei J, Sieper J (2009) The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68:777–783

    Article  CAS  PubMed  Google Scholar 

  15. Barrey C, Roussouly P, Le Huec JC, D’Acunzi G, Perrin G (2013) Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22:S834–S841

    Article  PubMed  Google Scholar 

  16. Shin JK, Lee JS, Goh TS, Son SM (2014) Correlation between clinical outcome and spinopelvic parameters in ankylosing spondylitis. Eur Spine J 23:242–247

    Article  PubMed  Google Scholar 

  17. Maxwell LJ, Zochling J, Boonen A, Singh JA, Veras MM, Tanjong Ghogomu E, Benkhalti Jandu M, Tugwell P, Wells GA (2015) TNF-alpha inhibitors for ankylosing spondylitis. Cochrane Database Syst Rev 4:CD005468

    Google Scholar 

  18. Baraliakos X, Listing J, von der Recke A, Braun J (2009) The natural course of radiographic progression in ankylosing spondylitis–evidence for major individual variations in a large proportion of patients. J Rheumatol 36:997–1002

    Article  PubMed  Google Scholar 

  19. Lee JS, Suh KT, Kim JI, Goh TS (2014) Analysis of sagittal balance of ankylosing spondylitis using spinopelvic parameters. J Spinal Disord Tech 27:E94–E98

    Article  PubMed  Google Scholar 

  20. Braun J, Sieper J (1996) The sacroiliac joint in the spondyloarthropathies. Curr Opin Rheumatol 8:275–287

    Article  CAS  PubMed  Google Scholar 

  21. McGonagle D, Gibbon W, O’Connor P, Green M, Pease C, Emery P (1998) Characteristic magnetic resonance imaging entheseal changes of knee synovitis in spondylarthropathy. Arthritis Rheum 41:694–700

    Article  CAS  PubMed  Google Scholar 

  22. Braun J, Bollow M, Eggens U, Konig H, Distler A, Sieper J (1994) Use of dynamic magnetic resonance imaging with fast imaging in the detection of early and advanced sacroiliitis in spondylarthropathy patients. Arthritis Rheum 37:1039–1045

    Article  CAS  PubMed  Google Scholar 

  23. Muche B, Bollow M, François RJ, Sieper J, Hamm B, Braun J (2003) Anatomical structures involved in early- and late-stage sacroiliitis in spondyloarthritis: a detailed analysis by contrast-enhanced magnetic resonance imaging. Arthritis Rheum 48:1374–1384

    Article  CAS  PubMed  Google Scholar 

  24. Braun J, Bollow M, Neure L, Seipelt E, Seyrekbasan F, Herbst H, Eggens U, Distler A, Sieper J (1995) Use of immunohistologic and in situ hybridization techniques in the examination of sacroiliac joint biopsy specimens from patients with ankylosing spondylitis. Arthritis Rheum 38:499–505

    Article  CAS  PubMed  Google Scholar 

  25. Laloux L, Voisin MC, Allain J, Martin N, Kerboull L, Chevalier X, Claudepierre P (2001) Immunohistological study of entheses in spondyloarthropathies: comparison in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 60:316–321

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Bollow M, Fischer T, Reißhauer H, Sieper J, Hamm B, Braun J (2000) T cells and macrophages predominate in early and active sacroiliitis as detected by magnetic resonance imaging in spondyloarthropathies. Ann Rheum Dis 59:135–140

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Wang XB, Ellis JJ, Pennisi DJ, Song X, Batra J, Hollis K, Bradbury LA, Li Z, Kenna TJ, Brown MA (2017) Transcriptome analysis of ankylosing spondylitis patients before and after TNF-α inhibitor therapy reveals the pathways affected. Genes Immun 18:184–190

    Article  CAS  PubMed  Google Scholar 

  28. Zou J, Rudwaleit M, Brandt J, Thiel A, Braun J, Sieper J (2003) Downregulation of the nonspecific and antigen-specific T cell cytokine response in ankylosing spondylitis during treatment with infliximab. Arthritis Rheum 48:780–790

    Article  CAS  PubMed  Google Scholar 

  29. Baraliakos X, Davis J, Tsuji W, Braun J (2005) Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis before and after therapy with the tumor necrosis factor alpha receptor fusion protein etanercept. Arthritis Rheum 52:1216–1223

    Article  CAS  PubMed  Google Scholar 

  30. Braun J, Baraliakos X, Golder W, Brandt J, Rudwaleit M, Listing J, Bollow M, Sieper J, Van Der Heijde D (2003) Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthritis Rheum 48:1126–1136

    Article  CAS  PubMed  Google Scholar 

  31. Rudwaleit M, Baraliakos X, Listing J, Brandt J, Sieper J, Braun J (2005) Magnetic resonance imaging of the spine and the sacroiliac joints in ankylosing spondylitis and undifferentiated spondyloarthritis during treatment with etanercept. Ann Rheum Dis 64:1305–1310

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Song IH, Hermann K, Haibel H, Althoff CE, Listing J, Burmester G, Krause A, Bohl-Buhler M, Freundlich B, Rudwaleit M, Sieper J (2011) Effects of etanercept versus sulfasalazine in early axial spondyloarthritis on active inflammatory lesions as detected by whole-body MRI (ESTHER): a 48-week randomised controlled trial. Ann Rheum Dis 70:590–596

    Article  CAS  PubMed  Google Scholar 

  33. Lord PA, Farragher TM, Lunt M, Watson KD, Symmons DP, Hyrich KL (2010) Predictors of response to anti-TNF therapy in ankylosing spondylitis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 49:563–570

    Article  CAS  Google Scholar 

  34. Jackson RP, Peterson MD, McManus AC, Hales C (1998) Compensatory spinopelvic balance over the hip axis and better reliability in measuring lordosis to the pelvic radius on standing lateral radiographs of adult volunteers and patients. Spine (Phila Pa 1976) 23:1750–1767

    Article  CAS  Google Scholar 

  35. van der Heijde D, Landewe R, van der Linden S (2005) How should treatment effect on spinal radiographic progression in patients with ankylosing spondylitis be measured? Arthritis Rheum 52:1979–1985

    Article  CAS  PubMed  Google Scholar 

  36. Sieper J, van der Heijde D, Dougados M, Maksymowych WP, Scott BB, Boice JA, Berd Y, Bergman G, Curtis S, Tzontcheva A, Huyck S, Weng HH (2015) A randomized, double-blind, placebo-controlled, sixteen-week study of subcutaneous golimumab in patients with active nonradiographic axial spondyloarthritis. Arthritis Rheumatol 67:2702–2712

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Atteno M, Peluso R, Costa L, Padula S, Iervolino S, Caso F, Sanduzzi A, Lubrano E, Del Puente A, Scarpa R (2010) Comparison of effectiveness and safety of infliximab, etanercept, and adalimumab in psoriatic arthritis patients who experienced an inadequate response to previous disease-modifying antirheumatic drugs. Clin Rheumatol 29:399–403

    Article  PubMed  Google Scholar 

  38. Ritchlin CT, Kavanaugh A, Gladman DD, Mease PJ, Helliwell P, Boehncke WH, de Vlam K, Fiorention D, Fitzgerald O, Gottlieb AB, McHugh NJ, Nash P, Qureshi AA, Soriano ER, Taylor WJ, Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) (2009) Treatment recommendations for psoriatic arthritis. Ann Rheum Dis 68:1387–1394

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea

    Seung Min Son & Sung Hoon Choi

  2. Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, 1-10 Ami-Dong, Seo-Gu, Busan, 49241, Republic of Korea

    Jong Ki Shin, Tae Sik Goh & Jung Sub Lee

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  1. Seung Min Son
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Son, S.M., Choi, S.H., Shin, J.K. et al. Radiologic parameters of ankylosing spondylitis patients treated with anti-TNF-α versus nonsteroidal anti-inflammatory drugs and sulfasalazine. Eur Spine J 28, 649–657 (2019). https://doi.org/10.1007/s00586-019-05912-7

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  • DOI: https://doi.org/10.1007/s00586-019-05912-7

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