TNFi Therapy Did Not Prevent Joint Ankylosis in Young Patients With Spondyloarthritis

TNFi therapy failed to prevent the development of joint ankylosis despite a substantial reduction in inflammation with TNFi therapy.

In young patients with spondyloarthritis (SpA), tumour necrosis factor inhibitor (TNFi) therapy did not prevent the eventual development of joint ankylosis despite substantial reduction in inflammation, according to imaging study results published in Arthritis & Rheumatology.

Researchers retrospectively analyzed data from a local clinical adolescent rheumatology database and identified patients aged 12 to 23 years with a diagnosis of enthesitis-related arthritis with axial involvement or non-radiographic axial SpA. In addition, patients included in the cohort (n=29) were treated with TNFi therapy and showed signs of sacroiliitis on magnetic resonance imaging (MRI).

Scans of the sacroiliac joints were taken before and after TNFi treatment initiation and imaging results were assessed for markers of inflammation and structural irregularities, including fusion and fat metaplasia.

After mixed-effects regression analysis, investigators found that inflammation scores were significantly reduced in participants treated with TNFi therapy (P =.013); however, time of therapy initiation had no significant influence on inflammation scores (P =.125). Furthermore, they reported that TNFi therapy had no significant influence on fusion scores (P =.308) or fat metaplasia (P =.285).

Primary study limitations included the retrospective design and irregular nature of scan intervals.

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“We found that TNFi therapy in young patients with spondyloarthritis failed to prevent the eventual development of joint ankylosis in a young spondyloarthritis cohort, despite a substantial reduction in inflammation with TNFi therapy,” the researchers wrote.

Further studies are needed to fully understand the temporal relationships between TNFi therapy, structural damage, and inflammation.

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Bray TJP, Lopes A, Fisher C, Ciurtin C, Sen D, Hall-Craggs MA. Sacroiliac joint ankylosis In young spondyloarthritis patients receiving biologic therapy: observation of serial MRI scans [published online October 8, 2018]. Arthritis Rheumatol. doi:10.1002/art.40750