Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Differences in Clinical and Inflammation Outcomes in Patients with Axial Spondyloarthritis of Shorter and Longer Disease Duration After One Year Treatment with Etanercept.

Weibeta1,  Anja, Song2,  In-Ho, Hermann3,  Kay-Geert, Althoff3,  Christian, Freundlich4,  Bruce, Rudwaleit5,  Martin, Listing1,  Joachim

German Rheumatism Research Centre, Berlin, Germany
Charité Medical University, Campus Benjamin Franklin, Berlin, Germany
Charite Medical School, Berlin, Germany
University of Pennsylvania, Philadelphia, PA
Ev. Krankenhaus Hagen-Haspe, Hagen, Germany
Charité– Campus Benjamin Franklin, Berlin, Germany

Background/Purpose:

To investigate the influence of the disease duration on the outcome in patients with axial spondylarthritis (SPA)

Methods:

62 patients with axial SpA with a symptom duration of less than 5 years were treated with Etanercept (ETA) for one year, either with ETA until week 48 (n=40) or they were switched from sulfasalazine treatment in the first year to ETA in the second year from week 48 until week 108 (n=26), as part of the ESTHER trial (1). 52% of these patients had a diagnosis of radiographic axial SpA and 48% had radiographic sacroiliitis. The patients were stratified into two groups: less than 3 years and more than 3 years of symptom duration before inclusion into the trial. These two groups were compared for clinical, CRP and magnetic resonance imaging (MRI)-outcome parameters using analysis of covariance (ANCOVA) with baseline status as covariable. Spearman correlation coefficients are calculated to analyse the relationship between two variables.

Results:

Clinical parameters such as Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis metrology index (BASMI) showed significantly better improvement for short vs longer diseased patients (Table 1). The results for improvement of MRI inflammation score for sacroiliac joints (SIJ) and spine and for CRP showed no significant differences between the two groups (Table 1). In patients with SIJ score at baseline > 0 the change in BASDAI showed a correlation with the change in SIJ score in patients with a short disease duration (rho=0.4, p=0.05) and longer disease duration (rho=0.4, p=0.06). The correlation between spine score and BASDAI was weaker. Significant correlation between BASDAI and CRP was found for short diseased patients (rho=0.6, p=0.002) but not for longer diseased patients (rho=0.3, p=0.14). Interestingly, patients fulfilling the New York criteria for radiographic sacroiliitis did not differ from patients not fulfilling the criteria regarding change in BASDAI (p=0.97), BASFI (p=0.7), BASMI (p=0.21), CRP (p=0.93), MRI spine score (p=0.74) and MRI SIJ score (p=0.66).

Table 1. Mean outcome parameters at baseline, adjusted means under treatment with etanercept and adjusted mean changes from baseline. Adjustment was made for baseline status (95% confidence intervals (CI) were given).

 Means at baselineAdjusted means under ETA therapyAdjusted mean change (95% CI)
Parameter< 3 years n=32>=3 years n=34< 3 years n=32>=3 years n=34< 3 years n=32>= 3 years n=34p-value
BASDAI5.05.42.53.42.7 (2.1, 3.3)1.8 (1.2, 2.3)0.028
BASFI3.94.21.82.92.2 (1.7, 2.8)1.2 (0.7, 1.7)0.004
BASMI1.92.11.41.90.6 (0.3, 0.9)0.1 (-0.2, 0.4)0.012
CRP10.88.15.54.74.4 (1.6, 7.1)5.3 (2.5, 7.8)0.690
MRI spine score1.32.20.990.70.9 (0.3, 1.4)1.2 (0.6, 1.7)0.470
MRI SIJ score5.96.01.52.34.4 (3.7, 5.1)3.6 (2.9, 4.3)0.090

Conclusion:

In patients with early axial SpA treated with ETA for one year short diseased patients showed a better improvement in all clinical parameters such as BASDAI, BASFI and BASMI than longer diseased patients, but such a difference was not present for objective parameters of inflammation such as MRI inflammation and CRP. These data indicate that patients with longer symptom duration respond less well to TNF-blockade for reasons which go beyond structural damage.

[1]Song, I.-H. et al. 2011. Ann Rheum Dis. 2011 Apr;70(4):590–6.

To cite this abstract, please use the following information:
Weibeta, Anja, Song, In-Ho, Hermann, Kay-Geert, Althoff, Christian, Freundlich, Bruce, Rudwaleit, Martin, et al; Differences in Clinical and Inflammation Outcomes in Patients with Axial Spondyloarthritis of Shorter and Longer Disease Duration After One Year Treatment with Etanercept. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1329
DOI:

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