Abstract

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.

Original languageEnglish
Pages (from-to)631-638
Number of pages8
JournalRheumatology (United Kingdom)
Volume57
Issue number4
DOIs
Publication statusPublished - 1 Apr 2018

Cite this

@article{5b739479e3e1483eb0d45d262901524f,
title = "Bone formation in ankylosing spondylitis during anti-tumour necrosis factor therapy imaged by 18F-fluoride positron emission tomography",
abstract = "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-na{\"i}ve 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.",
keywords = "Ankylosing spondylitis, Anti-TNF, Bone biopsy, Magnetic resonance imaging, Positron emission tomography, Treatment monitoring",
author = "Bruijnen, {Stefan T.G.} and Verweij, {Nicki J.F.} and {van Duivenvoorde}, {Leonie M.} and Nathalie Bravenboer and Baeten, {Dominique L.P.} and {van Denderen}, {Christiaan J.} and {van der Horst-Bruinsma}, {Irene E.} and Voskuyl, {Alexandre E.} and Martijn Custers and {van de Ven}, {Peter M.} and Bot, {Joost C.J.} and Boden, {Bouke J.H.} and Lammertsma, {Adriaan A.} and Hoekstra, {Otto S.H.} and Raijmakers, {Pieter G.H.M.} and {van der Laken}, {Conny J.}",
year = "2018",
month = "4",
day = "1",
doi = "10.1093/rheumatology/kex448",
language = "English",
volume = "57",
pages = "631--638",
journal = "Rheumatology",
issn = "1462-0324",
publisher = "Oxford University Press",
number = "4",

}

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

VL - 57

SP - 631

EP - 638

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 4

ER -