Document Detail

Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: evidence of a relationship between inflammation and new bone formation.
MedLine Citation:
PMID:  19116919     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine whether a vertebral corner that demonstrates an active corner inflammatory lesion (CIL) on magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) is more likely to evolve into a de novo syndesmophyte visible on plain radiography than is a vertebral corner that demonstrates no active inflammation on MRI. METHODS: MRI scans and plain radiographs were obtained for 29 patients recruited into randomized placebo-controlled trials of anti-tumor necrosis factor alpha (anti-TNFalpha) therapy. MRI was conducted at baseline, 12 or 24 weeks (n=29), and 2 years (n=22), while radiography was conducted at baseline and 2 years. A persistent CIL was defined as a CIL that was found on all available scans. A resolved CIL was defined as having completely disappeared on either the second or third scan. A validation cohort consisted of 41 AS patients followed up prospectively. Anonymized MRIs were assessed independently by 3 readers who were blinded with regard to radiographic findings. RESULTS: New syndesmophytes developed significantly more frequently in vertebral corners with inflammation (20%) than in those without inflammation (5.1%) seen on baseline MRI (P<or=0.008 for all reader pairs). They also developed more frequently in vertebral corners where inflammation had resolved than in those where inflammation persisted after anti-TNF treatment. This was confirmed in the analysis of the prospective cohort, in which significantly more vertebral corners with inflammation (14.3%) compared with those without inflammation (2.9%) seen on baseline MRI developed new syndesmophytes (P<or=0.003 for all reader pairs). CONCLUSION: Our findings indicate that a syndesmophyte is more likely to develop from a prior inflammatory lesion, supporting a relationship between inflammation and ankylosis.
Walter P Maksymowych; Praveena Chiowchanwisawakit; Tracey Clare; Susanne J Pedersen; Mikkel Østergaard; Robert G W Lambert
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Publication Detail:
Type:  Clinical Trial, Phase III; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  60     ISSN:  0004-3591     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-12     Completed Date:  2009-03-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  93-102     Citation Subset:  AIM; IM    
University of Alberta, Department of Medicine, Edmonton, Alberta, Canada.
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MeSH Terms
Antibodies, Monoclonal / therapeutic use
Antirheumatic Agents / therapeutic use
Cervical Vertebrae / immunology,  pathology*
Lumbar Vertebrae / immunology,  pathology*
Magnetic Resonance Imaging*
Middle Aged
Osteitis / immunology,  pathology*
Osteogenesis / immunology*
Spondylitis, Ankylosing / drug therapy,  immunology,  pathology*
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Antirheumatic Agents; 0/infliximab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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