title: Different effects of anti-TNF-alpha biologic drugs on the small bowel macroscopic inflammation in patients with ankylosing spondylitis.
abstract: OBJECTIVE
  Considering the ability of anti-TNF alpha drugs to lower the burden intestinal inflammation in patients with inflammatory bowel disease (IBD), and the similarity between IBD and ankylosing spondylitis (AS) regarding inflammatory intestinal involvement, we aimed to investigate the impact of anti-TNF alpha biologic therapy on subclinical intestinal inflammation in AS patients.
  
  
  METHODS
  Between January 2008 and December 2013, 38 AS patients and 23 controls were enrolled in the study and investigated with small bowel videocapsule endoscopy examination and ileocolonoscopy. Each tertile of the small bowel (proximal, mid and distal) was assessed by calculating the Lewis score based on the image stream.
  
  
  RESULTS
  The Lewis scores were significantly higher in the AS group compared to controls (580.9 ± 818 vs. 81 ± 121, p<0.001). 16 patients (42.1%) were on anti-TNF alpha therapy (Adalimumab (n = 5), Infliximab (n = 5) or Etanercept (n = 6)).31.3% of them used NSAIDs simultaneously, compared with 77.3% of the other patients (p<0.01). Their Lewis scores were lower compared to the other patients for the entire small bowel (306 ± 164 vs. 790 ± 1038, p = 0.015), its proximal and distal tertiles (238 ± 154 vs. 560 ± 543, p = 0.021, and 140 ± 189 vs. 300 ± 220, p = 0.027, respectively). The Lewis score was also lower in patients receiving Adalimumab/Infliximab compared to those on Etanercept for the entire bowel and its distal tertile (262 ± 165 vs. 380 ± 148, p = 0.069 and 62 ± 101 vs. 273 ± 236, p = 0.060, respectively).
  
  
  CONCLUSIONS
  Anti-TNF alpha therapy in patients with AS reduces the subclinical intestinal inflammation, but the magnitude seems to depend upon the class anti-TNF alpha agent used (Clinical Trials. gov NCT00768950).
authors.forename: A
authors.initials: A
authors.lastname: Chitul
authors.forename: A M
authors.initials: AM
authors.lastname: Voiosu
authors.forename: Mădălina
authors.initials: M
authors.lastname: Marinescu
authors.forename: Simona
authors.initials: S
authors.lastname: Caraiola
authors.forename: Adriana
authors.initials: A
authors.lastname: Nicolau
authors.forename: Georgeta Camelia
authors.initials: GC
authors.lastname: Badea
authors.forename: Magda Ileana
authors.initials: MI
authors.lastname: Pârvu
authors.forename: R A
authors.initials: RA
authors.lastname: Ionescu
authors.forename: B R
authors.initials: BR
authors.lastname: Mateescu
authors.forename: M R
authors.initials: MR
authors.lastname: Voiosu
authors.forename: C R
authors.initials: CR
authors.lastname: Băicuş
authors.forename: M
authors.initials: M
authors.lastname: Rimbaş
mesh_terms: D000068879:Adalimumab / Q000008:administration & dosage; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D053705:Capsule Endoscopes; D003113:Colonoscopy / Q000379:methods; D004359:Drug Therapy, Combination; D000068800:Etanercept / Q000008:administration & dosage; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006785:Hospitals, University; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D000069285:Infliximab / Q000008:administration & dosage; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept