Kickas.org Forums Ankylosing Spondylitis General Discussion Highlights in Spondylitis Research Bone Formation in AS During anti-TNF Therapy

https://www.ncbi.nlm.nih.gov/pubmed/29329443

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-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.

KEYWORDS:
ankylosing spondylitis; anti-TNF; bone biopsy; magnetic resonance imaging; positron emission tomography; treatment monitoring

PMID: 29329443 DOI: 10.1093/rheumatology/kex448

in the results paragraph of this article I noticed the term "bridging syndesmophytes". I've noticed this term used along with "flowing syndesmophytes" throughout my recent x-rays. I understand from googling it is essentially bony spur growth as a result of AS. Is this basically what the fusion is and kind of the building blocks for bamboo spine? I assume once they are detected on an x-ray they are never erased, but meds can control additional growth?

They would show up even sooner on an M.R.I. scan. I think that such drugs as Anti-TNF are intended to stop or at least control such problems.

From what I understand, anti-TNF drugs are supposed to slow progression,act on the inflammation, as inflammation leads to progressions of spinal bridging and fusion. As pointed out, MRIs pick up such progressions faster than X-Rays. When you next see your rheumatologist ask for details.
BTW - the anti-inflammatories such as ibuprofen can really muck up the gut, also bad for the heart. So beware the NSAIDs. My own gut is right kicked to bits by them.
No I did not use the TNF drugs, I followed the dietary advice, and gained control that way.

If your inflammation is controlled; whether through diet or say TNF or a combo, and blood markers are normal, will the syndesmophytes disappear?

Quick follow up: if syndesmophytes do disappear would a measure of mobility increase?

Jackson- syndesmophytes have appeared... they can be made to disappear ? Please run this past yr rheumatologist ! -

I take Lansoprazole (Prevacid) and it protects my stomach from the bad effects of NSAIDs. I would recommend it those who suffer stomach problems due to taking NSAIDs.

Lansoprazole, a PPI. Best check unwanted side effects of PPIs...!!!

https://www.drugs.com/sfx/lansoprazole-side-effects.html

Plus the PPIs are anticholinergic, can lead to dementia - hence you will note the injunction not to take for more than three years.

Common Side Effects of Prevacid (Lansoprazole) Drug Center - RxList
https://www.rxlist.com/prevacid-side-effects-drug-center.htm
Side effects of Prevacid include headache, nausea, diarrhea, stomach pain, ... The following adverse reactions were reported by the treating physician to have a ...