In:
Arthritis & Rheumatology, Wiley, Vol. 71, No. 1 ( 2019-01), p. 82-90
Abstract:
To investigate the impact of tumor necrosis factor inhibitor ( TNF i) treatment and inflammation control on radiographic progression in early ankylosing spondylitis ( AS ) over 4 years. Methods We included a total of 215 patients with early AS (symptom duration 〈 10 years) treated with TNF i (the TNF i group; n = 135) or with nonsteroidal antiinflammatory drugs ( NSAID s) (the control group; n = 80). Two blinded readers assessed radiographic progression using the modified Stoke Ankylosing Spondylitis Spine Score ( mSASSS ). Inflammation control was inferred from C‐reactive protein ( CRP ) levels time‐averaged between 2 radiologic assessments. Linear mixed modeling was used to estimate mSASSS changes over radiographic intervals as well as the impact of clinical factors on outcomes. Results The TNF i group had longer disease duration, a higher baseline CRP level, and a higher Bath Ankylosing Spondylitis Disease Activity Index than did controls. The time‐averaged CRP level over radiographic intervals was lower with TNF i treatment than with NSAID treatment (mean ± SD 0.27 ± 0.30 mg/dl versus 0.61 ± 0.68 mg/dl; P 〈 0.001). Overall, mean ± SD mSASSS change over the 2‐year interval was 1.30 ± 2.97 units. In the multivariable model adjusted for age, smoking status, baseline CRP level, and the presence of syndesmophytes at baseline, the TNF i group showed less mSASSS change over the 2‐year interval (β = −0.90 [95% confidence interval {95% CI } −1.51, −0.29]). However, when a time‐averaged CRP level was additionally included, it significantly influenced the mSASSS change (β = 1.02 [95% CI 0.32, 1.71]), decreasing the estimated group difference (β = −0.52 [95% CI −1.17, 0.14]). NSAID indices of both groups were not associated with either time‐averaged CRP levels or mSASSS changes. Conclusion Effective suppression of inflammation by TNF i treatment decreases radiographic progression in early AS .
Type of Medium:
Online Resource
ISSN:
2326-5191
,
2326-5205
DOI:
10.1002/art.2019.71.issue-1
Language:
English
Publisher:
Wiley
Publication Date:
2019
detail.hit.zdb_id:
2754614-7
Permalink
