title: Inflammatory and fatty lesions in the spine and sacroiliac joints on whole-body MRI in early axial spondyloarthritis--3-Year data of the ESTHER trial.
abstract: OBJECTIVE
  To assess the relationship between active inflammation and development of chronic lesions in the spine and sacroiliac (SI)-joints on MRI in early axial spondyloarthritis (SpA) during treatment with etanercept.
  
  
  METHODS
  Here, we analyzed the 41 patients of the ESTHER trial, who were treated with etanercept over 3 continuous years and of whom MRIs were available for baseline, year 2, and year 3. MRIs were scored for active inflammation (STIR sequences) and chronic changes (T1 sequence) such as fatty lesions, erosions, and ankylosis in the SI joints and spinal vertebral units (VUs).
  
  
  RESULTS
  The mean fatty lesion scores increased between baseline and year 2 both in the spine (1.13 at baseline vs. 1.40 at year 2, p = 0.0254) and in the SI joints (4.76 at baseline vs. 5.46 at year 2, p = 0.27), but we found no further increase of the fatty lesion score between years 2 and 3. New fatty lesions at years 2 and 3 developed nearly exclusively in SI joint quadrants and VUs in which active MRI inflammation was present at baseline. Fatty lesions disappeared only in 3 SI joint quadrants and in none of VUs at years 2 and 3. Erosion and ankylosis scores remained unchanged.
  
  
  CONCLUSIONS
  Our data indicate a relationship between the presence of active MRI inflammation and the new development of fatty lesions. Furthermore, there was no increase of fatty lesions during continuous treatment of axial SpA patients with etanercept after successful suppression of active inflammation. Whether this is predictive of stopping radiographic progression needs to be further investigated.
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Rheumatology, Med. Clinic I, Rheumatology, Hindenburgdamm 30, 12203 Berlin, Germany. Electronic address: in-ho@gmx.de.
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Song
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Mitte, Radiology, Berlin, Germany.
authors.forename: Kay-Geert
authors.initials: KG
authors.lastname: Hermann
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Rheumatology, Med. Clinic I, Rheumatology, Hindenburgdamm 30, 12203 Berlin, Germany.
authors.forename: Hildrun
authors.initials: H
authors.lastname: Haibel
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Mitte, Radiology, Berlin, Germany.
authors.forename: Christian E
authors.initials: CE
authors.lastname: Althoff
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Rheumatology, Med. Clinic I, Rheumatology, Hindenburgdamm 30, 12203 Berlin, Germany.
authors.forename: Denis
authors.initials: D
authors.lastname: Poddubnyy
authors.affiliation: German Rheumatism Research Center, Berlin, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Listing
authors.affiliation: German Rheumatism Research Center, Berlin, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Weiß
authors.affiliation: Division of Rheumatology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Freundlich
authors.affiliation: Pfizer, Germany, Berlin, Germany.
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Lange
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Rheumatology, Med. Clinic I, Rheumatology, Hindenburgdamm 30, 12203 Berlin, Germany; Klinik für Innere Medizin und Rheumatologie, Klinikum Bielefeld Rosenhöhe, Bielefeld, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Rudwaleit
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Rheumatology, Med. Clinic I, Rheumatology, Hindenburgdamm 30, 12203 Berlin, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Sieper
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging* / Q000473:pathology; D012720:Severity of Illness Index; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology; D025241:Spondylarthritis / Q000000981:diagnostic imaging* / Q000473:pathology; D051598:Whole Body Imaging; D055815:Young Adult
keywords: Ankylosing spondylitis; TNF-alpha-blocker; axial spondyloarthritis; magnetic resonance imaging; radiographic progression