PMID- 34857002 OWN - NLM STAT- MEDLINE DCOM- 20220203 LR - 20220203 IS - 1546-0096 (Electronic) IS - 1546-0096 (Linking) VI - 19 IP - 1 DP - 2021 Dec 2 TI - Changes over time in inflammatory and structural lesions at the sacroiliac joint in children with spondyloarthritis exposed and unexposed to tumor necrosis factor inhibitor. PG - 167 LID - 10.1186/s12969-021-00647-6 [doi] LID - 167 AB - BACKGROUND: The objective of this work was to describe magnetic resonance imaging (MRI) changes over time in inflammatory and structural lesions at the sacroiliac joint (SIJ) in children with spondyloarthritis (SpA) exposed and unexposed to tumor necrosis factor inhibitor (TNFi). METHODS: This was a retrospective, multicenter study of SpA patients with suspected or confirmed sacroiliitis who underwent at >/=2 pelvic MRI scans. Images were reviewed independently by 3 radiologists and scored for inflammatory and structural changes using the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ inflammation score (SIS) and structural score (SSS). Longitudinal, quantitative changes in patient MRI scans were measured using descriptive statistics and stratified by TNFi exposure. We used an average treatment effects (ATE) regression model to explore the average effect of TNFi exposure over time on inflammatory and structural lesions, adjusting for baseline lesion scores. RESULTS: Forty-six subjects were evaluated using the SIS (n = 45) and SSS (n = 18). Median age at baseline imaging was 13.6 years, 63% were male and 71% were white. Twenty-three subjects (50%) were TNFi exposed between MRI studies. The median change in SIS in TNFi exposed and unexposed subjects with a baseline SIS >/=0 was - 20.7 and - 14.3, respectively (p = 0.09). Eleven (85%) TNFi exposed and 8 (89%) unexposed subjects with a baseline SIS >/=0 met the SIS minimal clinically important difference (MCID; >/=2.5). Using the ATE model adjusted for baseline SIS, the average effect of TNFi on SIS in patients with a baseline SIS >/=2 was - 14.5 (p < 0.01). Unadjusted erosion change score was significantly worse in TNFi unexposed versus exposed subjects (p = 0.03) but in the ATE model the effect of TNFi was not significant. CONCLUSION: This study quantitatively describes how lesions in the SIJs on MRI change over time in patients exposed to TNFi versus unexposed. Follow-up imaging in TNFi exposed patients showed greater improvement than the unexposed group by most metrics, some of which reached statistical significance. Surprisingly, a majority of TNFi unexposed children with a baseline SIS>/=2 met the SIS MCID. Additional studies assessing the short and long-term effects of TNFi on inflammatory and structural changes in juvenile SpA are needed. CI - (c) 2021. The Author(s). FAU - Brandon, Timothy G AU - Brandon TG AD - Division of Rheumatology and Center for Pediatric Clinical Effectiveness at the Children's Hospital of Philadelphia, Department of Pediatrics, Philadelphia, USA. FAU - Xiao, Rui AU - Xiao R AD - Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. FAU - Peterson, Rosemary G AU - Peterson RG AD - Division of Rheumatology at the Children's Hospital of Philadelphia, Department of Pediatrics, Philadelphia, USA. FAU - Chauvin, Nancy A AU - Chauvin NA AD - Department of Radiology at Penn State Health Milton S. Hershey Children's Hospital, Hershey, PA, USA. FAU - Francavilla, Michael L AU - Francavilla ML AD - Department of Radiology at the Children's Hospital of Philadelphia and Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA. FAU - Biko, David M AU - Biko DM AD - Department of Radiology at the Children's Hospital of Philadelphia and Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA. FAU - Rumsey, Dax G AU - Rumsey DG AD - Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. FAU - Stoll, Matthew L AU - Stoll ML AD - Division of Pediatric Rheumatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA. FAU - Weiss, Pamela F AU - Weiss PF AUID- ORCID: 0000-0002-9724-0443 AD - Department of Pediatrics, Division of Rheumatology and Center for Pediatric Clinical Effectiveness at the Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, 2716 South Street, Room 11121, Philadelphia, PA, 19104, USA. weisspa@chop.edu. LA - eng GR - Innovative Research Award/Rheumatology Research Foundation/ PT - Journal Article PT - Multicenter Study DEP - 20211202 PL - England TA - Pediatr Rheumatol Online J JT - Pediatric rheumatology online journal JID - 101248897 RN - 0 (Tumor Necrosis Factor Inhibitors) SB - IM MH - Adolescent MH - Child MH - Female MH - Humans MH - Inflammation/*diagnostic imaging/*drug therapy MH - Magnetic Resonance Imaging MH - Male MH - Retrospective Studies MH - Sacroiliac Joint/*diagnostic imaging/physiopathology MH - Spondylarthritis/*diagnostic imaging/*drug therapy MH - Tumor Necrosis Factor Inhibitors/*therapeutic use PMC - PMC8638346 OTO - NOTNLM OT - DISEASE PROGRESSION OT - MAGNETIC RESONANCE IMAGING OT - PEDIATRICS OT - SACROILIAC JOINT OT - SPONDYOLARTHRITIS OT - TUMOR NECROSIS FACTOR INHIBITORS COIS- Dr. Weiss has served as a consultant for Lilly and Novartis. EDAT- 2021/12/04 06:00 MHDA- 2022/02/04 06:00 PMCR- 2021/12/02 CRDT- 2021/12/03 05:42 PHST- 2021/09/27 00:00 [received] PHST- 2021/11/09 00:00 [accepted] PHST- 2021/12/03 05:42 [entrez] PHST- 2021/12/04 06:00 [pubmed] PHST- 2022/02/04 06:00 [medline] PHST- 2021/12/02 00:00 [pmc-release] AID - 10.1186/s12969-021-00647-6 [pii] AID - 647 [pii] AID - 10.1186/s12969-021-00647-6 [doi] PST - epublish SO - Pediatr Rheumatol Online J. 2021 Dec 2;19(1):167. doi: 10.1186/s12969-021-00647-6.