TY - JOUR
T1 - Bone formation in ankylosing spondylitis during anti-tumour necrosis factor therapy imaged by 18F-fluoride positron emission tomography
AU - Bruijnen, Stefan T.G.
AU - Verweij, Nicki J.F.
AU - van Duivenvoorde, Leonie M.
AU - Bravenboer, Nathalie
AU - Baeten, Dominique L.P.
AU - van Denderen, Christiaan J.
AU - van der Horst-Bruinsma, Irene E.
AU - Voskuyl, Alexandre E.
AU - Custers, Martijn
AU - van de Ven, Peter M.
AU - Bot, Joost C.J.
AU - Boden, Bouke J.H.
AU - Lammertsma, Adriaan A.
AU - Hoekstra, Otto S.H.
AU - Raijmakers, Pieter G.H.M.
AU - van der Laken, Conny J.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Objectives. Excessive bone formation is an important hallmark of AS. Recently it has been demonstrated that axial bony lesions in AS patients can be visualized using 18F-fluoride PET-CT. The aim of this study was to assess whether 18F-fluoride uptake in clinically active AS patients is related to focal bone formation in spine biopsies and is sensitive to change during anti-TNF treatment. Methods. Twelve anti-TNF-naïve AS patients [female 7/12; age 39 years (SD 11); BASDAI 5.5 ± 1.1] were included. 18 F-fluoride PET-CT scans were performed at baseline and in two patients, biopsies were obtained from PET-positive and PET-negative spine lesions. The remaining 10 patients underwent a second 18F-fluoride PET-CT scan after 12 weeks of anti-TNF treatment. PET scans were scored visually by two blinded expert readers. In addition, 18F-fluoride uptake was quantified using the standardized uptake value corrected for individual integrated whole blood activity concentration (SUVAUC). Clinical response to anti- TNF was defined according to a≥20% improvement in Assessment of SpondyloArthritis international Society criteria at 24 weeks. Results. At baseline, all patients showed at least one axial PET-positive lesion. Histological analysis of PET-positive lesions in the spine confirmed local osteoid formation. PET-positive lesions were found in the costovertebral joints (43%), facet joints (23%), bridging syndesmophytes (20%) and non-bridging vertebral lesions (14%) and in SI joints (75%). After 12 weeks of anti-TNF treatment, 18F-fluoride uptake in clinical responders decreased significantly in the costovertebral (mean SUVAUC -1.0; P < 0.001) and SI joints (mean SUVAUC -1.2; P = 0.03) in contrast to non-responders. Conclusions. 18F-fluoride PET-CT identified bone formation, confirmed by histology, in the spine and SI joints of AS patients and demonstrated alterations in bone formation during anti-TNF treatment.
AB - Objectives. Excessive bone formation is an important hallmark of AS. Recently it has been demonstrated that axial bony lesions in AS patients can be visualized using 18F-fluoride PET-CT. The aim of this study was to assess whether 18F-fluoride uptake in clinically active AS patients is related to focal bone formation in spine biopsies and is sensitive to change during anti-TNF treatment. Methods. Twelve anti-TNF-naïve AS patients [female 7/12; age 39 years (SD 11); BASDAI 5.5 ± 1.1] were included. 18 F-fluoride PET-CT scans were performed at baseline and in two patients, biopsies were obtained from PET-positive and PET-negative spine lesions. The remaining 10 patients underwent a second 18F-fluoride PET-CT scan after 12 weeks of anti-TNF treatment. PET scans were scored visually by two blinded expert readers. In addition, 18F-fluoride uptake was quantified using the standardized uptake value corrected for individual integrated whole blood activity concentration (SUVAUC). Clinical response to anti- TNF was defined according to a≥20% improvement in Assessment of SpondyloArthritis international Society criteria at 24 weeks. Results. At baseline, all patients showed at least one axial PET-positive lesion. Histological analysis of PET-positive lesions in the spine confirmed local osteoid formation. PET-positive lesions were found in the costovertebral joints (43%), facet joints (23%), bridging syndesmophytes (20%) and non-bridging vertebral lesions (14%) and in SI joints (75%). After 12 weeks of anti-TNF treatment, 18F-fluoride uptake in clinical responders decreased significantly in the costovertebral (mean SUVAUC -1.0; P < 0.001) and SI joints (mean SUVAUC -1.2; P = 0.03) in contrast to non-responders. Conclusions. 18F-fluoride PET-CT identified bone formation, confirmed by histology, in the spine and SI joints of AS patients and demonstrated alterations in bone formation during anti-TNF treatment.
KW - Ankylosing spondylitis
KW - Anti-TNF
KW - Bone biopsy
KW - Magnetic resonance imaging
KW - Positron emission tomography
KW - Treatment monitoring
UR - http://www.scopus.com/inward/record.url?scp=85045030868&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/kex448
DO - 10.1093/rheumatology/kex448
M3 - Article
C2 - 29329443
AN - SCOPUS:85045030868
VL - 57
SP - 631
EP - 638
JO - Rheumatology
JF - Rheumatology
SN - 1462-0324
IS - 4
ER -