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Six-week treatment of axial spondyloarthritis patients with an optimal dose of nonsteroidal antiinflammatory drugs: early response to treatment in signal intensity on magnetic resonance imaging of the sacroiliac joints

Gaëlle Varkas UGent, Lennart Jans UGent, Heleen Cypers, Liesbet Van Praet, PHILIPPE CARRON, Dirk Elewaut UGent and Filip Van den Bosch UGent (2016) ARTHRITIS & RHEUMATOLOGY. 68(3). p.672-678
abstract
Objective. To evaluate the early effect of full-dose nonsteroidal antiinflammatory drugs (NSAIDs) on the extent and intensity of bone marrow edema of the sacroiliac (SI) joints on magnetic resonance imaging (MRI) in axial spondyloarthritis (SpA). Methods. A single-center, 6-week study of a cohort of consecutive patients with clinically suspected axial SpA was conducted. A total of 117 patients were screened. Forty patients who were diagnosed as having axial SpA and had presented with a positive MRI of the SI joints as defined by the Assessment of SpondyloArthritis international Society (ASAS) criteria were considered for a followup MRI after 6 weeks of an optimal dose of NSAIDs. Twenty patients completed the study. Disease activity was monitored by determining the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score every 2 weeks and the Bath Ankylosing Spondylitis Functional Index score at baseline and week 6. NSAID intake was assessed by the ASAS NSAID index. Primary end points were improvement in bone marrow edema of the SI joints on MRI and BASDAI response at week 6. Results. Approximately one-third of eligible patients newly diagnosed as having axial SpA were unable to continue the full-dose NSAID schedule. The median NSAID index was 97% in patients who completed the study. There was a reduction of 1.1 units (10.5%) in mean Spondyloarthritis Research Consortium of Canada (SPARCC) scores at week 6 in comparison to baseline (P=0.032). Overall, only 30% of the patients (6 of 20) had a minimal clinically important difference of 2.5 in SPARCC score. However, 80% of the patients displayed high-intensity lesions on STIR images at baseline, which decreased significantly at week 6 (P=0.011). There was a significant decrease in the relative intensity of the region of interest (P=0.007) and a mean decrease of 0.6 in the BASDAI score per 2 weeks of therapy (P=0.001). Only 29.4% of the patients met the BASDAI criteria for 50% improvement (BASDAI50) at week 6. Conclusion. Our findings indicate a high level of dropout among patients receiving full-dose NSAID therapy in daily practice. In those who tolerated NSAID therapy, there was no clinically relevant decrease in SPARCC scores and low BASDAI50 response. However, we found a decrease in signal intensity of bone marrow edema of the SI joints as an early response to 6 weeks of optimal NSAID therapy in patients newly presenting with axial SpA.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
RADIOGRAPHIC PROGRESSION, RESEARCH CONSORTIUM, ANKYLOSING-SPONDYLITIS, PLACEBO-CONTROLLED TRIAL, DOUBLE-BLIND, EFFICACY, INFLIXIMAB, INFLAMMATION, SAFETY, MULTICENTER
journal title
ARTHRITIS & RHEUMATOLOGY
Arthritis Rheumatol.
volume
68
issue
3
pages
672 - 678
Web of Science type
Article
Web of Science id
000371254300016
JCR category
RHEUMATOLOGY
JCR impact factor
6.918 (2016)
JCR rank
3/30 (2016)
JCR quartile
1 (2016)
ISSN
2326-5191
DOI
10.1002/art.39474
language
English
UGent publication?
yes
classification
A1
additional info
the last two authors contributed equally to this work
copyright statement
I have transferred the copyright for this publication to the publisher
id
7162815
handle
http://hdl.handle.net/1854/LU-7162815
date created
2016-03-25 15:00:07
date last changed
2016-12-19 15:42:39
@article{7162815,
  abstract     = {Objective. To evaluate the early effect of full-dose nonsteroidal antiinflammatory drugs (NSAIDs) on the extent and intensity of bone marrow edema of the sacroiliac (SI) joints on magnetic resonance imaging (MRI) in axial spondyloarthritis (SpA). 
Methods. A single-center, 6-week study of a cohort of consecutive patients with clinically suspected axial SpA was conducted. A total of 117 patients were screened. Forty patients who were diagnosed as having axial SpA and had presented with a positive MRI of the SI joints as defined by the Assessment of SpondyloArthritis international Society (ASAS) criteria were considered for a followup MRI after 6 weeks of an optimal dose of NSAIDs. Twenty patients completed the study. Disease activity was monitored by determining the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score every 2 weeks and the Bath Ankylosing Spondylitis Functional Index score at baseline and week 6. NSAID intake was assessed by the ASAS NSAID index. Primary end points were improvement in bone marrow edema of the SI joints on MRI and BASDAI response at week 6. 
Results. Approximately one-third of eligible patients newly diagnosed as having axial SpA were unable to continue the full-dose NSAID schedule. The median NSAID index was 97\% in patients who completed the study. There was a reduction of 1.1 units (10.5\%) in mean Spondyloarthritis Research Consortium of Canada (SPARCC) scores at week 6 in comparison to baseline (P=0.032). Overall, only 30\% of the patients (6 of 20) had a minimal clinically important difference of 2.5 in SPARCC score. However, 80\% of the patients displayed high-intensity lesions on STIR images at baseline, which decreased significantly at week 6 (P=0.011). There was a significant decrease in the relative intensity of the region of interest (P=0.007) and a mean decrease of 0.6 in the BASDAI score per 2 weeks of therapy (P=0.001). Only 29.4\% of the patients met the BASDAI criteria for 50\% improvement (BASDAI50) at week 6. 
Conclusion. Our findings indicate a high level of dropout among patients receiving full-dose NSAID therapy in daily practice. In those who tolerated NSAID therapy, there was no clinically relevant decrease in SPARCC scores and low BASDAI50 response. However, we found a decrease in signal intensity of bone marrow edema of the SI joints as an early response to 6 weeks of optimal NSAID therapy in patients newly presenting with axial SpA.},
  author       = {Varkas, Ga{\"e}lle and Jans, Lennart and Cypers, Heleen and Van Praet, Liesbet and CARRON, PHILIPPE and Elewaut, Dirk and Van den Bosch, Filip},
  issn         = {2326-5191},
  journal      = {ARTHRITIS \& RHEUMATOLOGY},
  keyword      = {RADIOGRAPHIC PROGRESSION,RESEARCH CONSORTIUM,ANKYLOSING-SPONDYLITIS,PLACEBO-CONTROLLED TRIAL,DOUBLE-BLIND,EFFICACY,INFLIXIMAB,INFLAMMATION,SAFETY,MULTICENTER},
  language     = {eng},
  number       = {3},
  pages        = {672--678},
  title        = {Six-week treatment of axial spondyloarthritis patients with an optimal dose of nonsteroidal antiinflammatory drugs: early response to treatment in signal intensity on magnetic resonance imaging of the sacroiliac joints},
  url          = {http://dx.doi.org/10.1002/art.39474},
  volume       = {68},
  year         = {2016},
}

Chicago
Varkas, Gaëlle, Lennart Jans, Heleen Cypers, Liesbet Van Praet, PHILIPPE CARRON, Dirk Elewaut, and Filip Van den Bosch. 2016. “Six-week Treatment of Axial Spondyloarthritis Patients with an Optimal Dose of Nonsteroidal Antiinflammatory Drugs: Early Response to Treatment in Signal Intensity on Magnetic Resonance Imaging of the Sacroiliac Joints.” Arthritis & Rheumatology 68 (3): 672–678.
APA
Varkas, G., Jans, L., Cypers, H., Van Praet, L., CARRON, P., Elewaut, D., & Van den Bosch, F. (2016). Six-week treatment of axial spondyloarthritis patients with an optimal dose of nonsteroidal antiinflammatory drugs: early response to treatment in signal intensity on magnetic resonance imaging of the sacroiliac joints. ARTHRITIS & RHEUMATOLOGY, 68(3), 672–678.
Vancouver
1.
Varkas G, Jans L, Cypers H, Van Praet L, CARRON P, Elewaut D, et al. Six-week treatment of axial spondyloarthritis patients with an optimal dose of nonsteroidal antiinflammatory drugs: early response to treatment in signal intensity on magnetic resonance imaging of the sacroiliac joints. ARTHRITIS & RHEUMATOLOGY. 2016;68(3):672–8.
MLA
Varkas, Gaëlle, Lennart Jans, Heleen Cypers, et al. “Six-week Treatment of Axial Spondyloarthritis Patients with an Optimal Dose of Nonsteroidal Antiinflammatory Drugs: Early Response to Treatment in Signal Intensity on Magnetic Resonance Imaging of the Sacroiliac Joints.” ARTHRITIS & RHEUMATOLOGY 68.3 (2016): 672–678. Print.