J Korean Rheum Assoc.  2008 Mar;15(1):39-47. 10.4078/jkra.2008.15.1.39.

Assessment of Clinical Effect and Changes of Sacroiliac Joint by CT and MRI in Patients with Ankylosing Spondylitis during Therapy with Etanercept

• Jeong YG
• Lee SY
• Kim HO
• Kim SK
• Kim JH
• Yoo WH
• Lee SI

• KMID: 1324507
• DOI: http://doi.org/10.4078/jkra.2008.15.1.39

Abstract

OBJECTIVE: To assess the clinical effect and acute inflammatory and chronic bony changes of the sacroiliac (SI) joints as detected by magnetic resonance (MR) and computerized tomography (CT) imaging in patients with ankylosing spondylitis (AS) during treatment with etanercept. METHODS: The all 16 patients with AS were treated with etanercept 25mg twice weekly subcutaneously and the clinical response was assessed by standardized parameters. Active inflammatory lesions and chronic bony changes of SI joints were assessed by the MR and CT images of the sacroiliac joints before and after treatment with etanercept. RESULTS: The mean disease duration was 13.1+/-0.69 years and the mean duration of treatment was 14.9+/-4.86 weeks. The mean BASDAI and BASFI score decreased significantly after etanercept treatment. The regression of active inflammation of sacroiliac joint was seen only in a patient with early disease stage of AS (18 months). However, no significant changes in acute inflammatory and chronic bony changes of the SI joints were found on MR and CT images after treatment of etanercept. CONCLUSION: Etanercept treatment showed good clinical response. However, no decrease in acute inflammatory and chronic bony changes of the sacroiliac joints was shown on MR and CT images in the AS patients had long-standing disease. Thus, it is suggested that etanercept should be used in early disease stage to obtain the radiographic improvement of sacroiliac joints.

Keyword

Ankylosing spondilitis; Etanercept; Sacroiliitis

Figure

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  Fig. 1. Scoring of chronic bony changes of the sacroiliac joints as assessed by axial CT images on the basis of The Modified New York criteria. (A) Grade 1, suspicious of bony erosions (arrows). (B) Grade 2, definite bony erosions and sclerosis (arrows). (C) Grade 3, more prominent bony erosions and severe sclerosis and blurring of the SI joint. (D) Grade 4, total ankylosis of entire sacroiliac joints.

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  Fig. 2. The comparison of two types of MR imaging showing active inflammatory lesions in sacroiliac joints. The oblique coronal T2-weighted image with fat suppression (A) and the oblique coronal T1-weighted image with fat suppression following intravenous administration of Gd-DTPA (B) demonstrate almost same patterns of increased signal intensity in the subchondral bone marrow (asterisks) within the iliac and sacral sides. In addition, these images show early erosion in left iliac sides (arrows).

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  Fig. 3. The erosions of the sacroiliac joints can be seen more clearly on axial CT image (A) than T2-weighted MR image with fat suppression (B).

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  Fig. 4. Chronic bony changes and active inflammatory lesions of the sacroiliac joints as assessed by MR and CT images between baseline and after 12 weeks of treatment of etanercept.

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  Fig. 5. An example of a patient with some progression of ankylosis of sacroiliac joint (arrow) over the treatment period. (A) At baseline and (B) after 12 weeks.

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  Fig. 6. An example of a patient with early disease stage of AS (18 months) showing significant regression of active inflammatory lesions of the sacroiliac joints after 12 weeks of treatment with Etanercept.

Reference

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