Structural Effect of Tumor Necrosis Factor Inhibitors on Spine in Spondylarthritis Patients with Hip Involvement

Aim: The structural efficacy of TNF alpha in spine in spondylarthrities (SpA) has been reported in several studies with prolonged follow. None of these studies did however assessed their effects in a particulary severe population of SpA with hip disease. Methods: A comparative multicenter cohort study has included two groups of SpA patients with Group 1: Patients under TNF inhibitors and group 2: TNF alpha inhibitors naive patients under conventional treatment. Clinical, biological and radiological (using mSASSS score and BASRI spine) evaluations were performed before applying anti TNF (T0), after 2 years (T2) and after a period of treatment with n ≥3 (Tn) and compared to group 2. Results: Groups 1 and 2 respectively included 24 and 21 patients. The sociodemographic and clinical characteristics of the disease as well as biological and radiological assessments at T0 were comparable between the two groups. Group 1 had however a more active disease and greater functional impairment. Evaluation at T2 showed a greater improvement of clinical and biological parameters of disease in Group 1. The evaluation showed at Tn a maintained clinical and biological effectiveness of TNF inhibitors in group 1. A structural deterioration of the spine was however noted in both groups with a Δ BASRI spine and Δ mSASSS comparable in both groups at T2 and Tn. Conclusion: Anti TNF seem ineffective on the structural progression of the spine particularly severe and advanced spondyloarthrites.