Suppression of inflammation and effects on new bone formation in ankylosing spondylitis: evidence for a window of opportunity in disease modification
Suppression of inflammation and effects on new bone formation in ankylosing spondylitis: evidence for a window of opportunity in disease modification
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DOI：
10.1136/annrheumdis-2011-200859
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发表时间：
2013-01-01
影响因子：
27.4
通讯作者：
Lambert, Robert G.
中科院分区：
文献类型：
--
作者：
Maksymowych, Walter P.;Morency, Nathalie;Lambert, Robert G.
尽管MRI数据支持强直性脊柱炎患者脊柱炎症与新骨形成之间的联系，但抗肿瘤坏死因子a疗法尚未被证明可以阻止新骨形成。作者的目的是证明，虽然急性病变完全解决，更先进的病变，特征是修复的证据，与新骨形成有关。方法对76名强直性脊柱炎患者在基线、12周和52周进行MRI扫描，这些患者被招募参加阿达木单抗治疗的安慰剂对照试验。在基线和104周时通过颈椎和腰椎侧位x线片评估新并发症状。匿名的MRI扫描由两名读者独立阅读，记录急性（A型）和晚期（B型）椎体角炎性病变（CIL）和脂肪病变的存在/不存在。作者使用广义线性潜在模型和混合模型分析来调整基线时症状/强直的程度。结果与A型CIL (2.9%) （p = 0.002）或无CIL (2.5%) （p < 0.0001）相比，B型CIL（16.7%）出现新症状的频率更高。基线和新椎体角脂肪病变发展超过52周也观察到这一点（分别为11.1% （p < 0.001）和6.8% (p = 0.03)）。在基线调整了症状/强直的程度后，与B型CIL (OR （95% CI 3.88, 1.20至- 12.57）和脂肪（OR 95% CI 4.83, 2.38至9.80）的关联是显著的。结论：我们的数据支持这样的假设，即新骨形成更可能发生在晚期炎性病变中，并通过脂肪化生过程进行，这为疾病改变提供了机会。
Objectives Although MRI data supports a link between spinal inflammation and formation of new bone in ankylosing spondylitis, anti-tumour necrosis factor a therapies have not been shown to prevent new bone formation. The authors aimed to demonstrate that while acute lesions resolve completely, more advanced lesions, characterised by evidence of reparation, are associated with new bone formation.Methods MRI scans were performed at baseline, 12 and 52 weeks in 76 ankylosing spondylitis patients recruited to a placebo-controlled trial of adalimumab therapy. New syndesmophytes were assessed on lateral radiographs of the cervical and lumbar spine at baseline and 104 weeks. Anonymised MRI scans were read independently by two readers who recorded the presence/absence of acute (type A) and advanced (type B) vertebral corner inflammatory lesions (CIL) and fat lesions. The authors used generalised linear latent and mixed models analysis to adjust for the extent of syndesmophytes/ankylosis at baseline.Results New syndesmophytes developed significantly more frequently from type B CIL (16.7%) compared with type A CIL (2.9%) (p = 0.002) or no CIL (2.5%) (p < 0.0001). This was also observed for both baseline and new vertebral corner fat lesions evolving over 52 weeks (11.1% (p < 0.001) and 6.8% (p = 0.03), respectively). The association with type B CIL (OR (95% CI 3.88, 1.20 to - 12.57) and fat (OR 95% CI 4.83, 2.38- to 9.80), p < 0.0001) was significant after adjustment for the extent of syndesmophytes/ankylosis at baseline.Conclusions Our data supports the hypothesis that new bone formation is more likely in advanced inflammatory lesions and proceeds through a process of fat metaplasia, supporting a window of opportunity for disease modification.