THU0360 INCREASING IMPACT ON STRUCTURAL DAMAGE WITH INCREASING CUMULATIVE INFLAMMATION AT THE SI-JOINT QUADRANT LEVEL IN AXIAL SPONDYLOARTHRITIS – 5-YEAR DATA FROM THE DESIR COHORT
Authors: Santiago Rodrigues-Manica, Alexandre Sepriano, Sofia Ramiro, Robert B.M. Landewé, Pascal Claudepierre, Anna Moltó, Maxime Dougados, Miranda van Lunteren, Désirée van der Heijde
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Axial inflammation is a key feature in axial SpA (axSpA). There is lack of data relative to the persistence of BME in the same anatomical quadrant (Q, 8 in total for both SIJ together), regardless of the overall presence of BME. <h3>Objectives:</h3> This study aims to investigate particular patterns of distribution of SIJ-BME across quadrants over time, their persistence over time, and their impact on clinical and structural outcomes. <h3>Methods:</h3> Patients from the DESIR cohort (early axSpA according to the rheumatologist) with MRI-SIJ available at baseline, 2 and 5 years were included. Each image was scored by 3 trained central readers blinded to chronological order. BME was considered positive if detected in ≥1/6 slices in each of the 8 quadrants, according to each individual reader. Four different patterns of BME over time were defined (no BME, sporadic pattern, fluctuating BME and persistent BME) considering all 8 quadrants (Figure). The effect of BME patterns on 5-year structural (mNY, mSASSS, ≥5 erosions and/or fatty lesions in MRI-SIJ) and clinical outcomes (BASFI, BASMI and ASQoL) was evaluated using multilevel generalised estimating equations (GEE) models (taking the individual reader data into account) and linear regression (using the agreement of ≥ 2 out of 3), as appropriate. All models were adjusted for relevant confounders including treatment (Table). <h3>Results:</h3> In total, 136 patients were included (age 34 (SD 9) years, 50% male, and 63% HLA-B27 positive). 'No BME' was seen in 63 patients (46%), the 'sporadic pattern' in 34 patients (25%), the 'fluctuating pattern' was seen in 21 patients (15%) and the 'persistent BME pattern' was seen in 18 patients (13%). Compared to the 'no BME' pattern (reference), the 'sporadic' [OR (95% CI): 2.1 (1.0;4.5)], 'fluctuating' [OR: 5.6 (2.2;14.4)] and 'persistent' [OR: 7.5 (2.8;19.6)] patterns were associated with higher likelihood to be mNY positive at 5-years, suggesting a gradient between cumulative inflammation and damage. Similar findings were observed for mNY as a continuous outcome variable and for ≥5 erosions and/or fatty lesions on spinal MRI as outcomes, but not for mSASSS (Table). There was no association between the BME patterns and the clinical outcomes. <h3>Conclusion:</h3> Only 13% of the patients showed persistent inflammation in the same Q over a 5-year period and in 15% inflammation was fluctuating across different Qs. More structural damage was found in patients with increasing cumulative levels of local inflammation in the quadrant. Even when BME (temporarily) disappears there is an important effect on structural outcomes, and that effect t is independent of treatment. <h3>Disclosure of Interests:</h3> Santiago Rodrigues-Manica Grant/research support from: Novartis, MSD, Speakers bureau: Novartis, Alexandre Sepriano: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant for: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Speakers bureau: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Robert B.M. Landewé: None declared, Pascal Claudepierre Consultant for: Honoraria from Novartis as steering committe of this survey, Anna Moltó: None declared, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Miranda van Lunteren: None declared, Désirée van der Heijde Consultant for: AbbVie, Amgen, Astellas, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, Union Chimique Belge