Radiographic vertebral fractures develop in patients with ankylosing spondylitis during 4 years of TNF-α blocking therapy.

OBJECTIVES: To determine the prevalence and incidence of radiographic vertebral fractures in ankylosing spondylitis (AS) patients treated with TNF-α blocking therapy for 4 years and to explore the relationship with patient characteristics, clinical assessments, radiographic damage, and bone mineral density (BMD). METHODS: This study included consecutive AS patients with active disease from the Groningen Leeuwarden AS (GLAS) cohort treated with TNF-α blocking therapy for 4 years and with available thoracic and lumbar radiographs at baseline and at 4 years. Vertebral fractures were assessed by two readers (mild: ≥20-<25%, moderate: ≥25-<40%, severe: ≥40% reduction in vertebral height). RESULTS: In 27 of 105 (26%) AS patients, radiographic vertebral fractures were observed at baseline. These patients were significantly older, had larger occiput-to-wall distance, and more spinal radiographic damage. During 4 years of TNF-α blocking therapy, 21 (20%) patients developed at least one new fracture. Older age, smoking, higher BASFI, low lumbar spine BMD (Z-score ≤-2), presence of moderate vertebral fractures, and use of anti-osteoporotic treatment at baseline were associated with the development of new fractures. Most fractures were mild and occurred in the thoracic spine. The improvement in lateral spinal mobility and lumbar spine BMD during treatment was significantly less in patients with new fractures (median change of 0.8 vs. 2.8 cm and 0.3 vs. 0.8 Z-score, respectively). CONCLUSIONS: The prevalence of radiographic vertebral fractures was high in AS patients with active disease. Although clinical assessments and BMD improved significantly, new vertebral fractures still developed during 4 years of TNF-α blocking therapy.

Reduced Occurrence Rate of Acute Anterior Uveitis in Ankylosing Spondylitis Treated with Golimumab - The GO-EASY Study.

OBJECTIVE: Acute anterior uveitis (AAU) is common in ankylosing spondylitis (AS). Golimumab (GOL), a tumor necrosis factor-α inhibitor (TNFi), has proven to be effective in the treatment of AS. To date, the effect of GOL on the incidence of AAU in AS is unknown. The objective was to study the AAU occurrence rate in patients with AS during GOL treatment and secondarily, the efficacy of GOL in daily clinical practice. METHODS: The study was a multicenter prospective study in a real-world setting in patients with AS who were treated with GOL for 12 months. The occurrence of AAU was assessed in the year before the initial TNFi treatment and during GOL treatment and calculated for the period at risk for a new AAU. Measures for disease activity [Ankylosing Spondylitis Disease Activity Score (ASDAS)] and treatment response [Assessment of Spondyloarthritis international Society (ASAS20 score)] were collected. RESULTS: In total, 93 patients (65% male, 55% TNFi-naive, 27% history of AAU) were included, with a median disease duration of 7 years and ASDAS score of 3.1. During GOL treatment, the AAU occurrence rate was reduced from 11.1 to 2.2 per 100 patient-years (rate-ratio 0.20, 95% CI 0.04-0.91). After 3 months of treatment, 41% of the patients experienced a clinically important improvement of the ASDAS score (p < 0.001) and 36% an ASDAS20 response (p < 0.001). At month 12, 49% had achieved an ASAS20 response (p < 0.001). CONCLUSION: In AS, the AAU occurrence rate and disease activity decreased significantly during GOL treatment. Therefore, GOL can be considered a good choice in patients with AS who need a TNFi, especially in cases of recurrent AAU. (EudraCT number: 2012-002458-21).

Wegener's Granulomatosis vasculitis and granuloma.

Wegener's Granulomatosis (WG) is an autoimmune disease with manifestations in different organ systems. The hallmark of WG is a necrotizing granulomatous inflammation of the upper and/or lower respiratory tract and systemic small vessel vasculitis which can involve multiple organ systems. The treatment of WG has evolved over the last decades. Steroid, cytotoxic and biologic therapies have been used leading to great improvements in outcome. However, still mortality is high and relapses are a major cause of mortality and morbidity. Despite intensified maintenance regimens and new possibilities of biologic therapies in WG the relapse rate is high. Even patients treated with high dose cytotoxic therapies in autologous stem cell treatment protocols have shown relapses in the course of disease. Increasing knowledge of the pathophysiology of granuloma in WG and new biologic therapies might be of great importance for future treatment of WG.