A COMPREHENSIVE post-hoc analysis of the ESTHER trial sheds new light on the connection between MRI-detected inflammation and clinical outcomes in patients with axial spondyloarthritis (axSpA) undergoing long-term treatment with the tumor necrosis factor (TNF) inhibitor etanercept. The study, which followed 76 patients with active axSpA over a 4.5-year period, utilised MRI imaging to assess inflammation in the sacroiliac (SI) joints and spine. This imaging data was then correlated with disease activity scores and treatment outcomes, providing valuable insights into the impact of inflammation resolution on long-term disease management.
The findings indicate that persistent inflammation, particularly osteitis in the SI joints as observed on MRI, is closely associated with higher disease activity as measured by the Axial Spondyloarthritis Disease Activity Score (ASDAS). For example, a higher SI joint osteitis score was significantly linked to increased ASDAS levels both at the same time point and six months later. This suggests that active inflammation not only reflects current disease activity but also predicts sustained activity over time, underscoring the importance of monitoring and addressing inflammation in axSpA management.
Conversely, the resolution of SI joint osteitis had profound clinical benefits. Patients who achieved a Berlin MRI osteitis score of ≤1 demonstrated markedly lower ASDAS levels at subsequent time points. They were also significantly more likely to reach key treatment milestones, including low disease activity (a fivefold increase in likelihood) and inactive disease status (a twofold increase). These findings highlight the importance of achieving inflammation resolution as a primary treatment goal in axSpA, with direct implications for improving patient quality of life and long-term health outcomes.
The study also emphasises the role of MRI as a critical tool in the evaluation and management of axSpA. By providing a visual and measurable indicator of inflammation, MRI enables clinicians to track therapeutic progress and make informed decisions about treatment adjustments. Long-term use of etanercept, as shown in this study, offers substantial potential for controlling inflammation and delivering durable clinical benefits.
Overall, this research underscores the importance of targeting inflammation resolution in axSpA and reinforces the utility of MRI in both diagnosis and treatment monitoring. The findings support the use of anti-TNF therapy not only to reduce disease activity but also to achieve lasting improvements in clinical outcomes, offering renewed hope for patients living with this challenging condition.
Aleksandra Zurowska, EMJ
Reference
Torgutalp M et al. Association between resolution of MRI-detected inflammation and improved clinical outcomes in axial spondyloarthritis under long-term anti-TNF therapy. RMD Open 2025; DOI: 10.1136/rmdopen-2024-004921.
