title: Assessment of therapeutic response in ankylosing spondylitis patients undergoing anti-tumour necrosis factor therapy by whole-body magnetic resonance imaging.
abstract: OBJECTIVE
  Multifocal musculoskeletal inflammation is common in ankylosing spondylitis (AS) and is effectively treated by expensive anti-TNF (tumour necrosis factor) therapy. This study evaluated assessment of response by whole-body (WB) MRI compared with clinical assessment in AS patients during etanercept therapy.
  
  
  METHODS
  Ten patients with AS underwent a 12-month therapy with etanercept. Clinical markers were monitored [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and C-reactive protein (CRP)] and patients underwent WBMRI (1.5 T, STIR and T1-weighted) at three different time points (0, 26 and 52 weeks). WBMRI was evaluated and correlated with clinical scores.
  
  
  RESULTS
  The BASDAI index decreased under therapy from 5.5 ± 0.5 (week 0) to 1.7 ± 0.5 (week 52, P < 0.05). CRP declined from 15.7 ± 2.2 mg/dl (week 0) to 0.9 ± 0.9 mg/dl (week 52, P < 0.05). In WBMRI, the sum of all lesions showed a significant decrease from week 0 (38.9 ± 3.4) to week 52 (2.2 ± 0.9, 94.3 % reduction). WBMRI detected more areas of synovitis and enthesitis than clinical examination alone.
  
  
  CONCLUSIONS
  AS activity significantly decreased under etanercept therapy, which was proven by clinical examination and WBMRI. WBMRI detected more inflammatory lesions than clinical examination alone. The results suggest that WBMRI improves the detection of inflammatory changes and the assessment of their course under therapy.
  
  
  CONCLUSIONS
  • Multifocal musculoskeletal inflammation in AS is effectively treated by anti-TNF therapy. • Inflammatory lesions can be assessed by clinical examination and whole-body MRI. • AS activity significantly decreased under therapy as shown by WBMRI/clinical examination. • WBMRI detected more inflammatory lesions than clinical examination alone. • WBMRI improves detection of inflammatory changes and may help evaluation of therapy.
authors.affiliation: Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Marchionini Str. 15, 81377 Munich, Germany. Martina.Karpitschka@med.uni-muenchen.de
authors.forename: Martina
authors.initials: M
authors.lastname: Karpitschka
authors.forename: Patrizia
authors.initials: P
authors.lastname: Godau-Kellner
authors.forename: Herbert
authors.initials: H
authors.lastname: Kellner
authors.forename: Annie
authors.initials: A
authors.lastname: Horng
authors.forename: Daniel
authors.initials: D
authors.lastname: Theisen
authors.forename: Christian
authors.initials: C
authors.lastname: Glaser
authors.forename: Bernhard
authors.initials: B
authors.lastname: Brandlhuber
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Sabine
authors.initials: S
authors.lastname: Weckbach
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage; D007155:Immunologic Factors / Q000627:therapeutic use; D007249:Inflammation; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage; D013167:Spondylitis, Ankylosing / Q000628:therapy*; D013585:Synovitis / Q000175:diagnosis; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D051598:Whole Body Imaging / Q000379:methods
chemical_list: D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000068800:Etanercept