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Bone marrow edema may improve with NSAIDs for patients with axial spondyloarthritis
Dropout rates from the use of full-dose NSAIDs were high among patients with axial spondyloarthritis, and while no clinical difference was seen in certain ratings of disease activity between patients who continued NSAIDs and patients who did not, bone marrow edema of the sacroiliac joints was reduced after 6 weeks in newly diagnosed patients, according to recently published research.
A group of 112 patients with early, suspected axial spondyloarthritis underwent MRI of the sacroiliac (SI) joints at baseline and week 6 following assessment. Assessment of SpondyloArthritis international Society was used to identify patients with axial spondyloarthritis. The Bath Ankylosing Spondylitis Disease Activity Index was administered every 2 weeks, and the Bath Ankylosing Spondylitis Functional Index was administered at baseline and week 6. The Spondyloarthritis Research Consortium of Canada (SPARCC) system was used to identify bone marrow edema of the SI joints based on eight 3-mm slices on MRI.
No bone marrow edema was identified in 72 patients, and 10 of the remaining 40 patients were excluded following nonadherence to a washout period of NSAID use prior to the baseline MRI. Twenty patients were included in the final analysis, 55% of whom were men with a median age of 32.7 years. C-reactive protein was elevated in 35% of patients at baseline, and 60% of patients were HLA-B27-positive.
Piroxicam at 20 mg daily was used by 70% of patients, and 150-mg diclofenac daily was used by 20%. Other NSAIDs included meloxicam 15 mg daily and etoricoxib 90 mg daily (5% each). No patients exhibited ankylosis of the SI joints.
After 6 weeks, the extent of lesions observed on MRI remained the same, but the intensity decreased over 6 weeks. No normal MRI results were observed at 6 weeks, however a decrease of 1.1 units in the SPARCC score was observed at week 6. Investigators found 30% of patients reached a minimal clinically important difference of 2.5 or greater at week 6. At baseline, 80% of patients had bone marrow edema lesions present on MRI and improvements were observed in 62.5% of patients at week 6. However, 25% of patients had no changes in intensity SPARCC scores and one patient developed a high intensity score at week 6. – by Shirley Pulawski
Disclosure: Varkas was supported by Ghent University Hospital (Clinical Research Funding grant) and Het Fonds voor Wetenschappelijk Reuma Onderzoek.