Letter to the Editor
Absence of Radiographic Progression at Two Years in a Cohort of Patients With Non-radiographic Axial Spondyloarthritis Treated With TNF-α Blockers
Ausencia de progresión radiológica a los 2 años en una cohorte de pacientes con espondiloartritis axial no radiológica tratados con terapia anti-TNF-α
Miriam Almirall
, Josue Guillermo López-Velandia, Joan Maymó
Corresponding author
Servicio de Reumatología, Parc de Salut Mar, Barcelona, Spain
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In studies evaluating radiological progression, patients do not receive anti-TNF-α or do it in a very small percentage. In 2 recent GESPIC cohort studies that assess the progression in the spine and sacroiliac joints of 95 patients with non-radiographic axial spondyloarthritis, only one patient received biological therapy. In these studies, 10.5% of patients showed progression of sacroiliitis and 7.4%, had spinal progression at 2 years follow-up.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The aim of this study was to evaluate the radiological progression in spine and sacroiliac joints at 2 years in a cohort of patients with non radiographic axial spondyloarthritis treated with anti-TNF-α.</p><p id="par0015" class="elsevierStylePara elsevierViewall">After a systematic review of medical records, we selected all patients with non radiological axial spondyloarthritis in our service and biological treatment with anti-TNF drugs at a standard dose for a minimum of two years and who had a baseline simple X-ray of the spine (cervical and lumbar lateral projection) and pelvis (anteroposterior view), and a follow-up X-ray 2 years later under the same treatment.</p><p id="par0020" class="elsevierStylePara elsevierViewall">All selected patients, 19, fulfilled the ASAS classification criteria for axial spondyloarthritis,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> but did not meet the New York radiological criteria for ankylosing spondylitis<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> (bilateral sacroiliitis at least grade 2 or unilateral grade 3–4).The 19 patients met the 2 entrnace criteria (back pain ≥three months and age of onset <45 years), 13 (65%) met the HLAB27 criteria and 6 (35%) the imaging, and thus, had acute inflammation on MRI, indicating sacroiliitis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We excluded patients with cutaneous psoriasis and inflammatory bowel disease.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Twelve patients received adalimumab, 2 infliximab, and 5 etanercept. Only 2 patients (10.5%) received concomitant therapy with NSAIDs for 3 or more months.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The baseline characteristics of the patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Two trained readers, JL and MA, examined the spinal radiographs according to the Stoke Ankylosing Spondylitis Spine Score (mSASSS)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and the sacroiliac joint x rays according to the grading system of the modified New York criteria for ankylosing spondylitis<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> in chronological order (baseline and follow-up at 2 years with the same biological treatment).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The intraclass correlation coefficients (ICC) for baseline rates were 1 in mSASSS and 0.4 index in grading the sacroiliac index and the ICC for the change rates were 1 in both reading systems.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The mSASSS index was zero units at baseline and at 2 years of treatment in all patients (none developed structural lesions in the spine).</p><p id="par0055" class="elsevierStylePara elsevierViewall">There was no sacroiliac radiological progression in any patient. None of the 19 patients in the cohort met the New York criteria for ankylosing spondylitis after 2 years of biological therapy with anti-TNF-α⋅</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, none of the patients in our cohort with non radiographic axial spondyloarthritis showed radiographic progression in the spine or sacroiliac joints after 2 years of treatment with anti-TNF, unlike other non-radiological spondylitis cohorts without biological therapy.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the first GESPIC cohort study, assessing sacroiliac radiographic progression at 2 years, the only predictor of radiographic progression were baseline CRP levels.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In our cohort, 47.4% of patients had CRP levels greater than 0.6<span class="elsevierStyleHsp" style=""></span>mg/dl. In this study by Poddubnyy et al.,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> the high level of CRP was also a significant predictor of progression of non-radiological spondylitis to ankylosing spondylitis and the presence of structural damage defined at baseline was also associated with greater progression to ankylosing spondylitis, although not statistically significant. In another study, Huerta-Sil et al.,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> also found that low-grade sacroiliitis was a prognostic factor for the development of spondylitis. In our cohort, 47.4% of patients had low-grade structural damage (grade I unilateral or bilateral sacroiliitis and/or unilateral grade II).</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the second GESPIC<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> cohort study evaluating spinal radiographic progression at 2 years, only the presence of basal syndesmophytes was a statistically significant predictor of progression in the non radiological spondylitis group, although there were was radiological progression in patients with no baseline syndesmophytes (the vast majority).</p><p id="par0075" class="elsevierStylePara elsevierViewall">In our cohort of patients, although they presented no baseline syndesmophytes, the fact that they showed no radiographic spinal or sacroilliac progression indicates that anti-TNF therapy may inhibit or delay progression in patients with axial non-radiological ankylosing spondylitis, although further studies are necessary with control groups and more patients. This data indicates the existence of a window of opportunity in which an effective treatment may alter the course of disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-03-19" "fechaAceptado" => "2013-04-24" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Almirall M, López-Velandia JG, Maymó J. Ausencia de progresión radiológica a los 2 años en una cohorte de pacientes con espondiloartritis axial no radiológica tratados con terapia anti-TNF-α. Reumatol Clin. 2014;10:134–135.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Parameters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patients with non-radiographic axial spondyloarthritis (n=19) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, mean±SD (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.9±7.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Duration of symptoms, mean±SD (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.89±5.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male gender, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (52.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HLAB27+, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (78.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smokers, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (36.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peripheral arthritis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (84.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Enthesitis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (36.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dactylitis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (5.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Uveitis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (26.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Family history of spondylitis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (36.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BASDAI>4, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCR>0.6<span class="elsevierStyleHsp" style=""></span>mg/dl, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (47.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR>20<span class="elsevierStyleHsp" style=""></span>mm/h, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (42.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Structural damage defined in sacroiliac joints (grade I unilateral or bilateral sacroiliitis and/or unilateral grade II), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (47.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Defined spinal structural damage (mSASSS≥1), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab476171.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Baseline Characteristics of Patients With Non-Radiographic Axial Spondyloarthritis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiographic findings following two years of infliximab therapy in patients with ankylosing spondylitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 15 | 25 |
| 2024 October | 26 | 34 | 60 |
| 2024 September | 41 | 15 | 56 |
| 2024 August | 50 | 29 | 79 |
| 2024 July | 38 | 36 | 74 |
| 2024 June | 71 | 36 | 107 |
| 2024 May | 43 | 43 | 86 |
| 2024 April | 53 | 32 | 85 |
| 2024 March | 41 | 27 | 68 |
| 2024 February | 29 | 29 | 58 |
| 2024 January | 26 | 21 | 47 |
| 2023 December | 29 | 25 | 54 |
| 2023 November | 36 | 18 | 54 |
| 2023 October | 34 | 51 | 85 |
| 2023 September | 60 | 40 | 100 |
| 2023 August | 33 | 28 | 61 |
| 2023 July | 32 | 27 | 59 |
| 2023 June | 36 | 24 | 60 |
| 2023 May | 40 | 19 | 59 |
| 2023 April | 28 | 8 | 36 |
| 2023 March | 44 | 15 | 59 |
| 2023 February | 39 | 28 | 67 |
| 2023 January | 28 | 20 | 48 |
| 2022 December | 52 | 39 | 91 |
| 2022 November | 57 | 15 | 72 |
| 2022 October | 39 | 41 | 80 |
| 2022 September | 43 | 31 | 74 |
| 2022 August | 39 | 37 | 76 |
| 2022 July | 40 | 40 | 80 |
| 2022 June | 33 | 41 | 74 |
| 2022 May | 40 | 38 | 78 |
| 2022 April | 35 | 53 | 88 |
| 2022 March | 49 | 53 | 102 |
| 2022 February | 44 | 21 | 65 |
| 2022 January | 26 | 32 | 58 |
| 2021 December | 31 | 41 | 72 |
| 2021 November | 41 | 43 | 84 |
| 2021 October | 80 | 52 | 132 |
| 2021 September | 41 | 30 | 71 |
| 2021 August | 52 | 32 | 84 |
| 2021 July | 60 | 24 | 84 |
| 2021 June | 35 | 41 | 76 |
| 2021 May | 29 | 20 | 49 |
| 2021 April | 56 | 66 | 122 |
| 2021 March | 53 | 23 | 76 |
| 2021 February | 22 | 29 | 51 |
| 2021 January | 30 | 25 | 55 |
| 2020 December | 33 | 12 | 45 |
| 2020 November | 21 | 20 | 41 |
| 2020 October | 31 | 20 | 51 |
| 2020 September | 29 | 8 | 37 |
| 2020 August | 35 | 22 | 57 |
| 2020 July | 11 | 11 | 22 |
| 2020 June | 31 | 11 | 42 |
| 2020 May | 44 | 14 | 58 |
| 2020 April | 30 | 19 | 49 |
| 2020 March | 13 | 7 | 20 |
| 2018 May | 4 | 1 | 5 |
| 2018 April | 30 | 8 | 38 |
| 2018 March | 56 | 8 | 64 |
| 2018 February | 21 | 3 | 24 |
| 2018 January | 31 | 11 | 42 |
| 2017 December | 28 | 5 | 33 |
| 2017 November | 37 | 6 | 43 |
| 2017 October | 29 | 5 | 34 |
| 2017 September | 37 | 6 | 43 |
| 2017 August | 46 | 5 | 51 |
| 2017 July | 50 | 6 | 56 |
| 2017 June | 71 | 9 | 80 |
| 2017 May | 71 | 10 | 81 |
| 2017 April | 49 | 5 | 54 |
| 2017 March | 41 | 3 | 44 |
| 2017 February | 27 | 4 | 31 |
| 2017 January | 32 | 4 | 36 |
| 2016 December | 61 | 12 | 73 |
| 2016 November | 52 | 14 | 66 |
| 2016 October | 58 | 11 | 69 |
| 2016 September | 64 | 22 | 86 |
| 2016 August | 65 | 14 | 79 |
| 2016 July | 36 | 20 | 56 |
| 2016 April | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 2 | 0 | 2 |
| 2015 July | 18 | 8 | 26 |
| 2015 June | 36 | 5 | 41 |
| 2015 May | 56 | 16 | 72 |
| 2015 April | 35 | 24 | 59 |
| 2015 March | 51 | 7 | 58 |
| 2015 February | 48 | 12 | 60 |
| 2015 January | 54 | 10 | 64 |
| 2014 December | 54 | 7 | 61 |
| 2014 November | 38 | 11 | 49 |
| 2014 October | 40 | 12 | 52 |
| 2014 September | 33 | 18 | 51 |
| 2014 August | 36 | 12 | 48 |
| 2014 July | 53 | 15 | 68 |
| 2014 June | 71 | 13 | 84 |
| 2014 May | 48 | 19 | 67 |
| 2014 April | 62 | 21 | 83 |
| 2014 March | 35 | 23 | 58 |
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