A quick decrease of bone marrow edema in sacroiliac joint could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis patients

Ruishan Yang, Hongda Liu, Mengpo Fan, Ruishan Yang, Hongda Liu, Mengpo Fan

Abstract

The purpose of this study was to investigate the correlation of bone marrow edema (BME) in sacroiliac joint (SIJ) with clinical characteristics and clinical response, and whether the quick decrease of BME could be served as a novel marker for dose tapering of etanercept in ankylosing spondylitis (AS) patients.Ninety active AS patients underwent etanercept treatment for 6 months were enrolled consecutively and classified into standard dose group (n = 37) and dose tapering group (n = 53). BME in SIJ and clinical response were assessed by SPARCC criteria and ASAS 40 response criteria, respectively. "Quick decrease of BME in SIJ" was defined as the decrease of SPARCC score≥50% from M0 to M1.BME in SIJ was positively correlated with pain VAS score, BASDAI score, CRP, IL-1β, IL-17, and TNF-α levels. ASAS 40 response rate at M6 was lower in dose tapering group than standard dose group, while higher in patients with a quick decrease of BME in SIJ than other patients. Besides, the ASAS 40 response rate in dose tapering group was similar to standard dose group in patients with a quick decrease of BME in SIJ but was lower than standard dose group in patients without a quick decrease of BME in SIJ at M6.A quick decrease of BME in SIJ predicts better treatment response to etanercept, and it might be served as a novel marker for dose tapering initiation of etanercept in AS patients.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Variations of SPARCC score and the percentage of patients with BME in SIJ after treatment. The SPARCC score in SIJ (A) and the percentage of patients with BME in SIJ (C) in total active AS patients were reduced at M1, M3, and M6 compared to M0, while no difference of SPARCC score (B) or percentage of patients with BME (D) in SIJ between dose tapering group and standard dose group at M0, M1, M3, or M6 was observed. Comparison of SPARCC score of SIJ at baseline (M0) and after treatment (M1, M3, and M6) was determined by pair t test; comparison of SPARCC score of SIJ between dose tapering group and standard dose group was determined by t test; comparison of percentage of patients with BMI in SIJ at baseline (M0) and after treatment (M1, M3, and M6) was determined by McNemar test, and comparison of percentage of patients with BMI in SIJ between dose tapering group and standard dose group was determined by Chi-square test. P < .05 was considered significant.
Figure 2
Figure 2
The percentage of patients with ASAS 40 after treatment. The percentage of patients with ASAS 40 was numerically increased in a time-dependent manner (A), which was relatively lower in dose tapering group compared to standard dose group at M6 (B). Comparison between two groups was evaluated by Chi-square test, P < .05 was considered significant.
Figure 3
Figure 3
The correlation of the BME in SIJ or the quick decrease of BME in SIJ with the ASAS 40 response rate. The percentage of patients with ASAS 40 was larger in patients with BME in SIJ compared to patients with non-BME in SIJ at M3 and M6 (A). Meanwhile, the percentage of patients with ASAS 40 was increased at M6 in patients with a quick decrease of BME in SIJ compared to others (B). Comparison between two groups was assessed using Chi-square test, P < .05 was considered significant.
Figure 4
Figure 4
Comparison of ASAS 40 response rate between subgroups after treatment. In patients with a quick decrease of BME in SIJ, no difference of the percentage of patients with ASAS 40 between dose tapering group and standard dose group was discovered at each visit (A), while in patients without a quick decrease of BME in SIJ, dose tapering group presented a lower percentage of patients with ASAS 40 compared to standard dose group at M6 (B). Comparison between two groups was determined by Chi-square test, P < .05 was considered significant.

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