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Ann Rheum Dis. 2008 Sep;67(9):1276-81. Epub 2007 Nov 15.

MRI in predicting a major clinical response to anti-tumour necrosis factor treatment in ankylosing spondylitis.

Author information

  • 1Medizinische Klinik I, Campus Benjamin Franklin, Charité - Medical School Berlin, Hindenburgdamm 30, 12200 Berlin, Germany. martin.rudwaleit@charite.de

Abstract

OBJECTIVE:

To evaluate the role of MRI in predicting a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) improvement of at least 50% (BASDAI 50) upon anti-tumour necrosis factor (TNF) therapy of active ankylosing spondylitis (AS).

METHODS:

MRIs from patients with active AS who participated in randomised controlled trials were analysed with respect to presence and extent of active inflammatory lesions as detected in the spine (n = 46), sacroiliac (SI) joints (n = 42) and both sites (n = 26). Univariate and multivariate logistic regression analyses were applied to evaluate MRI and clinical data in predicting a BASDAI 50 response.

RESULTS:

The Berlin MRI spine score (odds ratio (OR) 1.16, 95% CI 1.02 to 1.33) and disease duration (OR 0.9, 95% CI 0.63 to 0.97) were statistically significant predictors of a BASDAI 50 response using regression analysis while there was only a trend for C-reactive protein (CRP). The likelihood ratio (LR) for achievement of BASDAI 50 was increased in patients with a Berlin MRI spine score >/=11 (LR 6.7), disease duration <10 years (LR 4.2) and CRP >/=40 mg/litre (LR 3.4). All patients with two or three of these predictors improved clinically (as assessed by BASDAI) by at least 45%. Disease duration >20 years, normal CRP and no active inflammatory lesion in the spine were highly predictive of not achieving BASDAI 50. A trend was only found for the MRI score of SI joints to be predictive.

CONCLUSIONS:

Widespread inflammation in the spine as detected by MRI contributes to predicting a BASDAI 50 response in active patients with AS treated with anti-TNF agents.

PMID:
18006539
[PubMed - indexed for MEDLINE]
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