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In patients with ankylosing spondylitis, wide-spread inflammation of the spine detected by MRI is predictive of a major response to anti-tumor necrosis factor (TNF) therapy with infliximab or etanercept, German researchers report.

Dr. Martin Rudwaleit of Deutsches Rheumaforschungszentrum, Berlin, and colleagues examined MRIs from patients with active disease. Forty-six had active inflammatory lesions in the spine, 42 in the sacroiliac joints and 26 at both sites.

The investigators evaluated patient factors leading to a Bath Ankylosing Spondylitis Disease Activity Index improvement of at least 50 per cent (BASDAI 50). The findings are reported in the September issue of the Annals of the Rheumatic Diseases.

After 12 weeks of treatment, 54.3 per cent of the 46 patients with spinal MRIs achieved this response and the team determined that the Berlin MRI spine score, a validated indicator of inflammation, was a significant predictor (odds ratio, 1.16). Disease duration was the only other significant predictor in this group (odds ratio, 1.16).

C-reactive protein level showed a trend towards significance. This was also the case for MRI scoring of the sacroiliac joints.

"A short disease duration, high C-reactive protein levels and widespread spinal inflammation on MRI all contribute to predict a BASDAI 50 response," the researchers observe.

"Patients with two or three of these parameters are highly likely to achieve a good response," they add.

However, in comments to Reuter Health, Dr. Rudwaleit pointed out that "the extent of inflammation does not correlate at all with the subjective complaints as perceived by the patient."

This suggests that "MRI of the spine and sacroiliac joints contains a lot of relevant information."

"On the other hand," he continued, it "does not entirely reflect what is going on in the body in patients with ankylosing spondylitis."

Ann Rheum Dis 2008;67:1276-1281.