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Objective To evaluate the value of 3.0 T dynamic contrast-enhanced magnetic resonance imaging(MRI) in the diagnosis of hip joint lesions in patients with ankylosing spondylitis (AS).Methods Fifty-two AS patients with hip involvement were diagnosed in Department of Rheumatology in our hospital from January 2013 to December 2016.All patients underwent AS disease activity ankylosing spondylitis disease activity score (ASDAS)-C-reactive protein (CRP) score evaluation of hip joint acti-vity and hip joint disease activity was evaluated by doctors.According to ASDAS-CRP score,patients were divided into active disease 34 cases and remission for 18 cases.All patients underwent double hip MRI plain scan,dynamic enhanced scan and post-processing analysis after the diagnosis.Six regions of interest were selected in the abnormal synovial area around the hip joint.The time signal TIC curve was generated automatically,the shape of the curve was described and the early intensification rate of the third,fourth phase was measured.The early intensification rates of the active disease group and the remission group were analyzed statistically.Two independent samples t test was used for analysis,and P＜0.05 was regarded as statistically significant.The early intensification rate of the third,fourth phase were compared with the ASDAS-CRP score,the evaluation of hip joint activity in patients and the evaluation of hip joint activity were carried out by doctors taking care of the patients.Results The TIC curve of the active group was rising fast,followed by platform or fast rising.The curve of the remission group was slow rising.The inten-sification rate of the third,fourth phase [(116±9)％,(146±12)％ respectively] in the active phase group was higher than that of the remission group [(23±5)％,(43±14)％],and the difference was statistically significant (t=2.447,3.054;P＜0.05).The rate of synovial enhancement of the third,fourth phases was positively correlated with the ASDAS-CRP score (r=0.802,0.836,P=0.01),and the correlation was poor with evaluation of hip joint activity by patients (r=0.352,0.458;the P=0.02,0.01respectively),and the correlation was goodwith the evaluation of hip joint activity by doctors (r=0.652,0.717;P=0.01).Conclusion The shape and early enhancement rate of magnetic reson-ance dynamic enhanced TIC curve is valuable in assessing the disease activity of hip joint lesions in AS patients.
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Objective To investigate whether prolonged the interval of tumor necrosis factor (TNF)-α inhibitors (TNF-i) injection could continuously improve inflammatory biomarkers and imaging changes of sacroiliac joint and spine in spondyloarthritis (SpA).Methods A total of 154 SpA patients were included and 95 of them received TNF-α inhibitor therapy.TNF-i used in this study included etanercept,infliximab and adalimumab.The dose of etanercept was gradually reduced from 50 mg per week to every two weeks,every three weeks and then per month.The infusion of Infliximab was reduced from 4 mg/kg at 0,2,6 week to every 8 weeks,every 12 weeks and then every 16 weeks.The interval of Adalimumub injection was changed from 40 mg every two weeks to 3 weeks to 4 weeks and then to two months.The levels of inflammatory parameters,bath ankylosing spondylitis disease activity index (BASDAI),bath ankylosing spondylitis functional index (BASFI),ankylosing spondylitis disease activity score (ASDAS),spondyloarthritis research consortium of canada (SPARCC) scores of sacroiliac joint and fat metaplasia,bone erosion,sclerosis and ankylosis changes on magnetic resonance imaging (MRI) were investigated every 3 to 6 months.Radiograhs of spine were assessed by modified stoke ankylosing spondylitis spinal score (mSASSS) scores at baseline and 2 years.Analyses were performed by Paired t-test,Wilcoxon test,Mann-Whitney U test,Kruskal-Wallis and Chi-square test.Results After 3 months of treatment,erythrocyte sedimentation rate (ESR),c reactive protein (CRP),immunoglobulin A (IgA),BASDAI,BASFI,ASDAS and SPARCC scores were significantly lower than those of the baseline [13.00(6.00,31.00) mm/1 h vs 3.00 (2.00,6.00) mm/1 h,Z=-5.61;7.39(2.52,17.90) mg/L vs 1.88(1.21,3.75) mg/L,Z=-5.57;2.89(2.52,17.90) g/L vs 2.27(1.60,2.85) g/L,Z=-4.69;(2.57±1.43) vs (1.17±0.92),t=9.81;17.50(5.00,27.00) vs 4.00(0,11.00),Z=-6.69;2.62(2.02,3.52) vs 1.22(0.92,1.59),Z=-6.96;25.00(10.00,37.00) vs 12.00 (6.00,20.25),Z=-6.68;all P＜0.05].Compared to 3-6 months,SPARCC scores were significantly reduced during 2-3 years in the TNF-i group [12.00 (6.00,20.25) vs 7.00 (3.25,14.75),P=0.02].There were no significant progresses in fat metaplaisa,bone erosions,sclerosis or ankylosis during the follow-up period (61％,57％,x2=0.07,P=1.00;53％,43％,x2=0.40,P=0.75;31％,57％,x2=3.02,P=0.11;14％,7％,x2=0.43,P=0.66).The mSASSS scores were not different between TNF-i group and TNF-i group after 2 years of treatment [2.50 (0,8.00) vs 3.00 (0,8.00),Z=-0.30,P=0.76].Conclusion Prolonged the interval of TNF-i treatment could continuously improve bone marrow edema in SPA,whereas structural damages of sacroiliac joints and spine are not deteriorated.
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Objective To study the prediction value of C-reactive protein (CRP) level to ankylosing spondylitis disease activity score (ASDAS),the most widely used activity score in ankylosing spondylitis (AS).Methods A total of 386 patients with AS were enrolled and divided into 2 groups by CRP≥3.5 mg/L (n =266) and CRP ＜ 3.5 mg/L(n =120).ASDAS-CRP was evaluated in patients with CRP below the normal range (3.5 mg/L) in different subgroups.Three methods were used to test the consistency between ASDAS-CRP and ASDAS-erythrocyte sedimentation rate (ESR).Results The ASDAS-CRP showed a good correlation with the ASDAS-ESR when CRP level was ≥ 3.5 mg/L (r =0.899,P =0.000).In the group of CRP ＜ 3.5 mg/L,ASDAS-ESR showed better consistency with ASDAS-CRP when CRP level was below 1.5 mg/L(intra-class correlation coefficient 0.902;kappa coefficient 0.70).By the evaluation of variant gradient matrix,CRP 1.5 mg/L coincided with disease activity states.Conclusion There is good consistency between ASDAS-CRP and ASDAS-ESR.When CRP level is below the normal range,1.5 mg/L could be a cut-off value to calculate the optimal ASDAS-CRP score.
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Objective To investigate the value of ankylosing spondylitis(AS)disease activity score (ASDAS)and the Bath AS disease activity index(BASDAI)in evaluating disease activity in AS.Methods ASDAS and BASDAI were used to evaluate disease activity in patients with AS,taking the patients' global scores,physician global scores and treatment decision as the “gold standard” for disease activity.According to the “gold standard”,the patients were divided into low and high disease activity groups.Statistical analysis included descriptive statistics,linear correlation and regression and ROC curve.Results A total of 227 patients with AS were included.ASDAS and BASDAI showed good correlation with disease activity as reflected by the patients' global score[r for BASDAI,ASDAS based on ESR(ASDAS-ESR)and ASDAS based on C-reactive protein(ASDAS-CRP)were 0.713,0.698 and 0.725,respectively,P =0.000]and the physician global score(r for BASDAI,ASDAS-ESR and ASDAS-CRP were 0.771,0.782,0.847,respectively,P =0.000).Both scores showed good discriminative ability for high and low disease activity states.ASDAS-CRP had the highest sensitivity.Conclusion ASDAS is a promising tool for evaluating disease activity in AS patients.