The clinical and MRI effect of TNF-α inhibitor in spondyloarthritis patients with hip involvement: a real-world prospective clinical study

Abstract

Background: Hip involvement is an important cause of disability and poor prognostic in patients with spondyloarthritis (SpA). TNF-α inhibitor treatment had been demonstrated to be effective in SpA patients with hip arthritis, however, quantitative assessment with magnetic resonance imaging (MRI) in the long-term follow-up still needs further application.Methods: A total of 239 patients were involved in this study, MTX and SSZ were given as basic treatment. 165 patients received TNF-α inhibitor plus basic treatment and 74 patients received basic treatment only as control. The clinical symptoms were assessed at baseline, week 12, week 24, and week 52. The MRI performances of hip arthritis including bone marrow edema (BME) and synovitis were quantitatively assessed using Hip MRI Inflammation Scoring System (HIMRISS).Results: The clinical symptoms of ESR, CRP, BASDAI, Harris, and ASDAS-ESR of both groups got significant clinical remission at week 52 (p<0.001). However, the disease activity change levels at week 52 in control group were significantly worse than TNF group. In week 52, MRI performance showed significant remission trend in TNF-α inhibitor group versus baseline of which total HIMRISS scores decreased significantly ( 26.49±10.37 vs 20.59±9.41, p<0.001), but the control group only had slight improvement trend (p<0.05).Conclusions: TNF-α inhibitor could significantly and better improve the clinical and MRI manifestation of hip involvement in SpA patients than controls. Quantitative MRI assessment combined with clinical assessment could accurately evaluate the treatment effect of TNF-α for SpA patients with hip involvement, and help to guide targeted treatment.Trial registration: Chinese Clinical Trial Registry, ChiCTR-ONRC-11001846, Registered 28 November 2011. Retrospectively registered http://www.chictr.org.cn/showproj.aspx?proj=7701