7 ADÜ Týp Fakültesi Dergisi 2012; 13(3) : 7 - 11 Araþtýrma ANKÝLOZAN SPONDÝLÝTLÝ HASTALARDA ANTÝ-TNF-ALFA TEDAVÝ ÖNCESÝ VE SONRASI SAKROÝLÝAK EKLEMLERÝN MANYETÝK REZONANS ÝLE GÖRÜNTÜLENMESÝ 1 2 2 2 Þenol KOBAK , Fahrettin OKSEL , Vedat ÝNAL , Yasemin KABASAKAL ÖZET AMAÇ: Çalýþmanýn amacý, dirençli AS'li hastalarda, anti-TNF-alfa ilaçlarýn etkinliðini ve güvenirliðini yanýsýra, manyetik rezonans (MR) görüntüleme ile tedavi öncesi ve sonrasý sakroiliak eklem deðiþiklerini tespit etmektir. GEREÇ ve YÖNTEM: Modifiye New York taný kriterlerine göre AS tanýsý almýþ, 27 hasta çalýþmaya dahil edildi. Sakroiilitis bulgularý, anti-TNF-alfa tedavi öncesi ve sonrasý, Gd-MR ile tespit edildi. Sekiz hastaya, 4 haftada bir Ýnfliximab 4 mg/kg i.v. infüzyon verildi. Diðer 19 hastaya ise Etanercept 2x25 mg/hafta s.c. verildi. Deðerlendirilen klinik ve laboratuvar parametreler; BASDAÝ, BASFÝ, aðrý (VAS skoru), Schöber testi, göðüs ekspansiyonu, C-reaktif protein (CRP), eritrosit sedimentasyon hýzý (ESH). BULGULAR: Hastalarýn çoðu, anti-TNF-alfa tedavilerine iyi yanýt verdi. 24. haftanýn sonunda, takip edilen tüm parametrelerde iyileþme gözlendi. MR görüntüleme çalýþmalarýnda, anti-TNF-alfa tedavi sonrasý sadece 3 hastanýn sakroiliak eklem inflamasyonunda gerileme gözlendi. SONUÇ: Aktif AS'li hastalarda, 24. hafta sonunda anti-TNF-alfa ilaçlarý güvenilir ve etkin bulundu. BASDAÝ, BASFÝ, aðrý skorlarýnda belirgin düþüþ gözlendi. Fakat, sakroiliak eklemin akut inflamatuvar bulgularýnda, MR görüntüleme ile herhangi bir gerileme tespit edilmedi. Anahtar sözcükler: Ankilozan spondilit, anti-TNF-á ilaçlar, manyetik rezonans görüntüleme, sakroiliak eklem Magnetic Resonance Imaging of the Sacroiliac Joints in Ankylosing Spondilitis Before and After Therapy with Anti-Tumor Necrosis Factor Alpha SUMMARY OBJECTIVE: The goal of this study is to assess the changes in the sacroiliac joints (SÝ) by magnetic resonance imaging (MRI) in a 24-week follow-up period and to determine the efficacy and safety of anti-TNF-á therapies for refractory AS. MATERIALS and METHODS: Twenty-seven patients who met the modified New York criteria for AS were enrolled in this study. Activity of sacroiliitis was determined by Gd-MRI scan before and after anti-TNF-á treatment. Eight patients received infliximab at a dose of 4mg/kg by intravenous infusion over 2 hours at every 4 week. Other patients (n=19) were treated with 25mg subcutaneous etanercept twice weekly. Total observational period was 24 weeks. The clinical and laboratory variables included: Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), pain on a visual analog scale, Schober's index, chest expansion, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR). RESULTS: Most patients responded well to treatment of anti-TNF-á antagonists. At 24 weeks, there was an improvement in all of the measures followed. Imaging studies showed decreased inflammation of the SI joints after 24 weeks of treatment with anti-TNF-á therapies in 3 patients only. CONCLUSION: The anti-TNF-á therapy was found to be safe and effective in treating patients with active AS during 24-week study period. The BASDAI, BASFI, VAS of pain were decreased significantly, however we could not determine any regression of acute inflammatory changes of the SI joints as depicted by MRI. Key words: Ankylosing spondylitis, anti-TNF-á therapies, magnetic resonance imaging, sacroiliac joints 1 Þifa Üniversitesi Týp Fakültesi, Romatoloji BD, ÝZMÝR, TÜRKÝYE 2 Ege Üniversitesi Týp Fakültesi, Romatoloji BD, ÝZMÝR, TÜRKÝYE Ankylosing spondylitis (AS), the prototype of (SSZ), which has a proven beneficial effect for spondyloarthritis, is a chronic inflammatory peripheral arthritis and enthesitis and nearly 5,6 rheumatic diseases, leading to progressive spinal imperceptible for spondylitis . 1 ankylosis and deformity . Its pathogenesis is Tumor necrosis factor-alpha (TNF-á) has been 2 determined in sacroiliac joints of patients with AS. incompletely understood . The fýrst symptoms TNF-á mRNA and protein have been identified in the normally occur in the second and thýrd decade of life. sacroiliac joint (SI) biopsies of patients with active AS most offen starts with inflammation of the disease suggesting a role for this cytokine in the target sacroiliac joints (SI) and affect mainly the axial 7 3,4 organ inflammation . Over the past few years several skeleton . Until recently, non-steroidal anti- placebo controlled and open trials have shown a inflammatory drugs(NSAIDs) and physical therapy dramatic response in active AS to TNF-á blocking were the only accepted treatment. The only disease 8-10 modifying antirheumatic drug (DMARDs) that has agents . Studies on magnetic resonance imaging been demonstrated to be useful for AS is sulfasalasine (MRI) of SI joints in AS indicate that MRI enables