Presence of subclinical inflammation in axial spondyloarthritis patients with NSAID/anti-TNF-α drug-induced clinical remission

Objective To investigate the rate of subclinical inflammation in patients with axial spondyloarthritis (axSpA) with nonsteroidal anti-inflammatory drug (NSAID)/anti-tumor necrosis factor (TNE)-alpha drug-induced clinical remission and to explore factors influencing clinical and imaging remission. Methods One hundred twenty-five patients with axSpA followed up for at least 6 months were enrolled in this prospective study and randomly divided into two groups. Ninety patients were treated with anti-tumor necrosis factor (TNE)-alpha or antiTNE-oc combined with nonsteroidal anti-inflammatory drugs (NSAIDs) (anti-TNE-alpha treatment group), and thirty-five patients were treated with only NSAIDs (non anti-TNF-alpha treatment group). The improvements in the clinical remission rate, imaging remission rate, and disease parameters before and after the different treatments were compared. Risk factors for clinical and imaging remission were analyzed by multivariate logistic regression analysis. Results The clinical and imaging remission rate was increased after treatment especially in the anti-TNF-alpha group (P < 0.001). The remission rate of imaging in the group with clinical remission was higher than that in the group with clinical nonremission (P < 0.05). After treatment, the remission rates of imaging in the clinical remission and non-remission group were significantly higher than those before treatment (P < 0.0001). The results of multivariate logistic regression analysis showed that higher CRP was a risk factor for failure of clinical remission in axSpA (OR =2.034, 95% CI:1.595 2.617, P < 0.001), while higher ASDAScrp was a risk factor for failure of imaging remission (OR= 1.306, 95% CI:1.026 1.688, P < 0.05). Anti-TNF-alpha treatment was a protective factor for both clinical (OR = 0.234, 95% CI:0.091 0.605, P < 0.05) and imaging remission (OR= 0.511, 95% CI:0.286 - 0.914, P < 0.05). Conclusion Even after regular treatment, some clinical remission patients continued to have evidence of subclinical inflammation. Higher CRP and ASDAScrp are risk factors for clinical and imaging non-remission in axSpA respectively, Continuous NSAID treatment (more than 1 year) can effectively improve clinical and MRI inflammation in patients, but anti-TNF-alpha treatment is more beneficial for clinical and imaging remission.

Automated summary

The aim of this study was to investigate the rate of subclinical inflammation in patients with axial spondyloarthritis (axSpA) treated with nonsteroidal anti-inflammatory drugs (NSAIDs)/anti-tumor necrosis factor (TNF)-alpha drugs and to identify factors influencing clinical and imaging remission. The results showed that treatment with anti-TNF-alpha significantly increased the clinical and imaging remission rate. Higher CRP and ASDAScrp levels were identified as risk factors for non-remission, while anti-TNF-alpha treatment was found to be a protective factor. Continuous NSAID treatment for more than 1 year effectively improved clinical and MRI inflammation.