The Clinical and MRI Effect of TNF-α Inhibitor in Spondyloarthritis Patients with Hip Involvement：A Real-World Prospective Clinical Study

Background: Hip involvement is an important cause of disability and poor prognostic in patients with spondyloarthritis (SpA). TNF-α inhibitor treatment had been demonstrated to be effective in SpA patients with hip arthritis, however, quantitative assessment with magnetic resonance imaging (MRI) in the long-term follow-up still needs further application. This study was performed to quantitatively assess the detailed clinical remission and MRI changes of hip involvement under the treatment of TNF-α inhibitor versus control in SpA patients. Methods:  A total of 239 SpA patients with hip arthritis were involved in this study and MTX and SSZ were given as basic treatment. 165 of them received TNF-α inhibitor plus basic treatment and 74 patients in the control group received basic treatment only. The clinical symptoms were assessed at baseline, week 12, week 24, and week 52. The MRI performances of hip arthritis including bone marrow edema (BME) and synovitis were quantitatively assessed at baseline and week 52 using Hip MRI Inflammation Scoring System (HIMRISS). Findings: The clinical symptoms of ESR, CRP, BASDAI, Harris, and ASDAS-ESR of both groups got significant clinical remission at week 52 (p<0.001). However, the disease activity change levels at week 52 in control group were significantly worse than TNF group. In week 52, MRI performance showed significant remission trend in TNF-α inhibitor group versus baseline of which total HIMRISS scores decreased significantly ( 26.49±10.37 vs 20.59±9.41, p<0.001), but the control group only had slight improvement trend (p<0.05).  Interpretation: TNF-α inhibitor could significantly improve the clinical and MRI manifestation of hip involvement in SpA patients, and the treatment effect was better than controls. Quantitative MRI assessment combined with clinical assessment could accurately and comprehensively evaluate the treatment effect of TNF for SpA patients with hip involvement , and it will help to guide accurate and targeted treatment.    Funding: This work was supported by the National Basic Research Program of China (No. 2015CB553704) and National Natural Science Foundation of China(No.81871273). Declaration of Interest: We declare that all authors do not have a financial conflict of interest. Ethical Approval: The study was approved by the ethics committee of Xijing Hospital of China (instruction number: 20110303-7).