Site-specific resolution of enthesitis in patients with axial spondyloarthritis treated with tumor necrosis factor inhibitors

Abstract

Background Enthesitis is a hallmark of spondyloarthritis (SpA) with a substantial impact on quality of life. Reports of treatment effectiveness across individual enthesitis sites in real-world patients with axial SpA (axSpA) are limited. We investigated the evolution of enthesitis following tumor necrosis factor inhibitor (TNFi) initiation in axSpA patients, both cumulatively and at specific axial and peripheral sites. Methods AxSpA patients in the Swiss Clinical Quality Management Registry were included if they initiated a TNFi, had an available Maastricht Ankylosing Spondylitis Enthesitis Score, modified to include the plantar fascia (mMASES, 0–15), at start of treatment and after 6 and/or 12 months and ≥12 months follow-up. Logistic regression models were utilized to analyze explanatory variables for enthesitis resolution. Results Overall, 1668 TNFi treatment courses (TCs) were included, of which 1117 (67%) had active enthesitis at baseline. Reduction in mMASES at the 6- and 12-month timepoints was experienced in 72% and 70% of TCs, respectively. Enthesitis resolution at 6/12 months occurred in 37.9%/43.0% of all TNFi TCs and 40.7%/50.9% of first TNFi TCs. At 6 months, a significant reduction in the frequency of enthesitis was observed at all sites, except for the Achilles tendon and plantar fascia among first TNFi TCs, while at 12 months, reduction was significant at all sites in both TC groups. Enthesitis resolved in 60.3–77% across anatomical sites, while new incident enthesitis occurred in 4.0–13.5% of all TNFi TCs at 12 months. Both baseline and new-incident enthesitis occurred most frequently at the posterior superior iliac spine and the fifth lumbar spinous process. Younger age and lower mMASES at baseline were predictors of complete enthesitis resolution, while female sex and second- or later-line TNFi treatment were associated with persistence of enthesitis at 12 months. Conclusion In real-world axSpA patients treated with a TNFi, enthesitis improved in the majority of patients across all anatomical sites. Significant improvement at the Achilles and plantar fascia entheses was observed only at 12 months. Complete and site-specific enthesitis resolution occurred in ≥40% and ≥60% of TCs evaluated at 12 months, with a low incidence of new site-specific enthesitis. Trial registration Not applicable.

Sehnenpathologien im Bereich des Fußes – Inflammation versus Degeneration: wo liegen die Unterschiede?

“…Die Enthesitis kann auch bei juvenilen Erkrankungsformen oftmals als wesentliches und frühes Symptom einer SpA oder Psoriasisarthritis (PsA) diagnostiziert werden 22 . Diese manifestiert sich als Entzündung an der fibrokartilaginären oder fibroossären Insertion von Sehnen und Bändern und kann damit sowohl das periphere (bevorzugt Achillessehne und Plantarfaszie) als auch axiale Skelett befallen.…”

“…Die Therapie der arthritis-assoziierten Enthesitis erfolgt konservativ. Neben symptomatischen, physikalischen Massnahmen mit guter Evidenz für die extrakorporale Stosswellentherapie der Plantarfasciitis spielen die Biologika eine wichtige Rolle 22 . Komplette Remissionen von knapp 50% über einen Zeitraum von 12 Monaten im Zusammenhang einer TNF alphaTherapie der ax SpA werden berichtet.…”

Tofacitinib for Spondyloarthropathy Related Pubic Symphisitis

“…Anti-TNF and IL-17 inhibitors have both been well-documented to control enthesitis. 5 Recently JAK inhibitors have also been shown to help control enthesitis. 6 In our patient, whose pubic symphisitis was resistant to NSAIDS, Tofacitinib controlled the inflammatory symptoms and also reduced the need for NSAIDS.…”