Journal
JOURNAL OF RHEUMATOLOGY
Volume 43, Issue 9, Pages 1704-1712Publisher
J RHEUMATOL PUBL CO
DOI: 10.3899/jrheum.160003
Keywords
REACTIVE PROTEIN; RADIOGRAPH; MAGNETIC RESONANCE IMAGING; ANKYLOSING SPONDYLITIS; TUMOR NECROSIS FACTOR; GOLIMUMAB
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Objective. Serum C-reactive protein (CRP) associates with radiographic progression in patients with ankylosing spondylitis (AS) untreated with tumor necrosis factor (TNF) antagonists. We assessed correlations between serum CRP and radiographic progression/magnetic resonance imaging (MRI)-detected inflammation after 2 years of anti-TNF therapy. Methods. Patients with active AS receiving golimumab (GOL)/placebo through Week 16 (early escape) or Week 24 (crossover by design), followed by GOL through 4 years, had sera/images obtained through Week 208. Lateral spinal radiographs and spinal MRI were scored with the modified Stoke AS Spine Score (mSASSS) and the AS spine MRI activity (ASspiMRI-a) score, respectively. ANOVA assessed differences based on CRP levels and mSASSS progression. The relationships between CRP levels and mSASSS/ASspiMRI-a were assessed by Spearman correlation and logistic regression. Results. Of the randomized GO-RAISE patients, 299 (84.0%) had pre-and posttreatment spinal radiographs. Larger proportions of patients with Week 104 CRP >= 0.5 mg/dl (n = 47) versus < 0.5 mg/dl (n = 236, 40.4% vs 22.9%, p = 0.0121) had mSASSS changes >= 2 at Week 104. Across several visits, serum CRP demonstrated weak associations with mSASSS change (r(s) <= 0.21, p < 0.05, n = 262-293) and moderate associations with ASspiMRI-a change (r(s) = -0.33 to 0.54, p < 0.05, n = 65-89). Higher baseline CRP was associated with increased risk for syndesmophytes at Week 104/Week 208, and large, short-term decreases in CRP from baseline to Week 14/Week 24 also yielded increased syndesmophyte formation risk. Conclusion. Elevated CRP after 2 years of anti-TNF treatment correlated with greater radiographic progression risk at 4 years. Elevated CRP at baseline or Week 14/Week 24 of anti-TNF treatment weakly predicted subsequent radiographic progression and modestly predicted residual spinal inflammation in patients with AS treated with anti-TNF. Findings are useful regarding new treatment options in patients treated with anti-TNF. ClinicalTrials.gov: NCT00265083.
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