Body weight, gender and response to TNF-α blockers in axial spondyloarthritis.

OBJECTIVE: The objective of this study was to determine whether BMI and gender could lead to a different response rate to anti-TNF agents in patients affected by axial SpA. METHODS: One hundred and seventy patients with active axial SpA (defined as a BASDAI ≥ 4) treated with an anti-TNF agent [adalimumab (ADA), etanercept (ETA), infliximab (IFX)] were retrospectively evaluated. Patients were divided according to the baseline BMI as normal weight (BMI < 25), overweight (BMI 25-30) and obese (BMI ≥ 30). After 12 months of treatment a 50% improvement of the initial BASDAI (BASDAI50) was the primary end point and BASDAI ≤ 1 was the secondary end point. RESULTS: After 12 months of anti-TNF treatment, 67.8% of men and 46.2% of women reached the BASDAI50 (P = 0.01). According to BMI categories, the rate of BASDAI50 achievement decreased from 72.8% in normal weight subjects to 54.5% in overweight and 30.4% in obese subjects (P < 0.001). In the logistic regression analysis, the best independent predictors of failure to obtain a BASDAI50 response at the 12th month of therapy in axial SpA patients were female gender [odds ratio (OR) 3.23 (95% CI 1.52, 7.14)] and a BMI ≥ 30 [OR 3.57 (95% CI 1.15, 11.11)]. Analysing outcomes based on IFX therapy (the larger subgroup), the BASDAI50 response rate fell from 79.0% in normal weight subjects to 56.7% in overweight and 16.7% in obese subjects (P < 0.001). No significant differences were observed with ADA and ETA. CONCLUSION: Data suggest that being female, overweight and mostly obese is associated with a lower rate of success in obtaining response status in axial SpA patients treated with anti-TNF drugs. Body weight could represent a modifiable factor to reach the best outcome in axial SpA patients treated with TNF blockers.

Quality of life in patients following percutaneous PMMA acetabuloplasty for acetabular metastasis due to carcinoma.

Pain is the main symptom of acetabular osteolysis from metastatic carcinoma, and it is frequently associated with pathologic fractures. Radiotherapy alone usually is not effective for pain control, and it does not allow weight bearing. Surgical procedures requiring an aggressive approach and consequently high morbidity are rarely indicated in patients with multiple metastases. Polymethylmethacrylate (PMMA) has been widely used in oncologic and spinal surgery as a bone filler. We evaluated the functional results of percutaneous injection of PMMA in 20 patients (24 acetabula) with acetabular osteolysis from metastatic carcinoma. Patients were assessed before and after percutaneous acetabuloplasty, evaluating pain, mobility of the hip joint, general condition, use of analgesics, using the SF-36, QLQ-C30, Eastern Cooperative Oncology Group (ECOG) Performance Scale and Harris Hip Score. There was a marked clinical improvement in all patients during the first six post-operative months, with gradual worsening thereafter from deterioration of their general condition over the 12-month follow-up period. Percutaneous acetabuloplasty is reliable and effective in the short term, with a statistically significant reduction of pain and improvement in quality of daily life.