Şenol KOBAK, Fahrettin OKSEL, Vedat İNAL, Yasemin KABASAKAL

ANKİLOZAN SPONDİLİTLİ HASTALARDAANTİ-TNF-ALFA TEDAVİ ÖNCESİ VE SONRASI SAKROİLİAK EKLEMLERİN MANYETİK REZONANS İLE GÖRÜNTÜLENMESİ

AMAÇ: Çalışmanın amacı, dirençli AS'li hastalarda, anti-TNF-alfa ilaçların etkinliğini ve güvenirliğini yanısıra, manyetik rezonans (MR) görüntüleme ile tedavi öncesi ve sonrası sakroiliak eklem değişiklerini tespit etmektir.GEREÇ ve YÖNTEM: Modifiye New York tanı kriterlerine göre AS tanısı almış, 27 hasta çalışmaya dahil edildi. Sakroiilitis bulguları, anti-TNF-alfa tedavi öncesi ve sonrası, Gd-MR ile tespit edildi. Sekiz hastaya, 4 haftada bir İnfliximab 4mg/kg i.v. infüzyon verildi. Diğer 19 hastaya ise Etanercept 2x25mg/hafta s.c. verildi. Değerlendirilen klinik ve laboratuvar parametreler; BASDAİ, BASFİ, ağrı (VAS skoru), Schöber testi, göğüs ekspansiyonu, C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH).BULGULAR: Hastaların çoğu, anti-TNF-alfa tedavilerine iyi yanıt verdi. 24.haftanın sonunda, takip edilen tüm parametrelerde iyileşme gözlendi. MR görüntüleme çalışmalarında, anti-TNF-alfa tedavi sonrası sadece 3 hastanın sakroiliak eklem inflamasyonunda gerileme gözlendi. SONUÇ: Aktif AS'li hastalarda, 24.hafta sonunda anti-TNF-alfa ilaçları güvenilir ve etkin bulundu. BASDAİ, BASFİ, ağrı skorlarında belirgin düşüş gözlendi. Fakat, sakroiliak eklemin akut inflamatuvar bulgularında, MR görüntüleme ile herhangi bir gerileme tespit edilmedi

Anahtar Kelimeler:

Ankilozan spondilit, anti-TNF-α ilaçlar, manyetik rezonans görüntüleme, sakroiliak eklem

Magnetic Resonance Imaging of the Sacroiliac Joints in Ankylosing Spondylitis Before and After Therapy with Anti-Tumor Necrosis Factor Alpha

OBJECTIVE: The goal of this study is to assess the changes in the sacroiliac joints (Sİ) by magnetic resonance imaging (MRI) in a 24-week follow-up period and to determine the efficacy and safety of anti-TNF-α therapies for refractory AS. MATERIAL and METHODS: Twenty-seven patients who met the modified New York criteria for AS were enrolled in this study. Activity of sacroiliitis was determined by Gd-MRI scan before and after anti-TNF-α treatment. Eight patients received infliximab at a dose of 4 mg/kg by intravenous infusion over 2 hours at every 4 week. Other 19 patients were treated with 25mg subcutaneous etanercept twice weekly The total observational period was 24 weeks. The clinical and laboratory variables included: Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), pain on a visual analog scale, Schober's index, chest expansion, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR). RESULTS: Most patients responded well to treatment of anti-TNF-α antagonists. At 24 weeks, there was an improvement in all of the following measures. Imaging studies showed decreased inflammation of the SI joints after 24 weeks of treatment with anti-TNF-α therapies in only 3 patients. CONCLUSION: The anti-TNF-α therapies was safe and effective in treating patients with active AS during 24- week study period. The BASDAI, BASFI, VAS of pain were decreased well. But we could not determine any regression of acute inflammatory changes of the SI joints as depicted by MRI.

Keywords:

Ankylosing spondylitis, anti-TNF-α therapies, magnetic resonance imaging, sacroiliac joints,

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