title: Efficacy of anti-TNF in patients with spondyloarthritis in absence of any imaging sign.
abstract: OBJECTIVE
  Some clinical pictures satisfy spondyloarthritis criteria without any detected imaging signs and the question sometimes arises in clinical daily practice if biologics should be started. Our aim was to evaluate anti-TNF efficacy in patients with clinical but not imaging (radiographic, CT-scan, MRI) signs of spondyloarthritis.
  
  
  METHODS
  This retrospective study concerned patients with axial spondyloarthritis fulfilling European Spondyloarthritis Study Group (ESSG) criteria, treated with anti-TNF after failure of conventional therapies. Therapeutic responses, rated according to the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)-50% or 20 mm and ASAS-20 or -40 definitions, were evaluated after 12 months. Factors associated with those responses were also sought. Propensity score was used to check thereafter whether there were interactions with some baseline variables.
  
  
  RESULTS
  Among 385 patients included, 257 with imaging signs had significantly more frequent therapeutic responses (P=0.0005). About 40% of the spondyloarthritis patients without imaging signs responded to anti-TNF. The response rate was significantly higher in HLA-B27 carriers with initial imaging signs (P=0.028). Furthermore, responders were younger at biotherapy onset, with lower Bath Ankylosing Spondylitis Functional Index (BASFI) and pain visual analog scale score, and higher C-reactive protein (CRP), compared to non-responders. After weighted calculation, the prediction of response to TNF-blockers was quite similar in both groups.
  
  
  CONCLUSIONS
  The percentage of patients with exclusively clinical signs who responded to anti-TNF was far from negligible. Regardless the HLA-B27 status, having imaging signs of spondyloarthritis does not provide a superiority of response to anti-TNF compared to the absence of imaging sign. The absence of any imaging sign in patients with spondyloarthritis should therefore not lead to the exclusion of anti-TNF therapy.
authors.affiliation: Service de rhumatologie, CHU-hôpitaux de Rouen, hôpital de Bois-Guillaume, 147, avenue du Maréchal-Juin, 76230 Bois-Guillaume, France.
authors.forename: Aurélia
authors.initials: A
authors.lastname: Bisson-Vaivre
authors.forename: Didier
authors.initials: D
authors.lastname: Alcaix
authors.forename: Charles
authors.initials: C
authors.lastname: Zarnitsky
authors.forename: Laurent
authors.initials: L
authors.lastname: Pueyo
authors.forename: Alain
authors.initials: A
authors.lastname: Daragon
authors.forename: Karine
authors.initials: K
authors.lastname: Lanfant-Weybel
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Dacher
authors.forename: Olivier
authors.initials: O
authors.lastname: Vittecoq
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loët
authors.forename: Vincent
authors.initials: V
authors.lastname: Goëb
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D025241:Spondylarthritis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha