Clinical and MRI predictors of Clinical Response in Axial Spondyloarthritis

Spondyloarthritis is a family of diseases that includes inflammation of the spine and commonly results in restricted motion and disability. Ankylosing spondylitis, the prototypic form of the disease, is characterized by bony changes on X-ray. Earlier or milder disease, however, may have changes visible only on MRI, and has been called non-radiographic axial spondyloarthritis (nr-axSpA). The classification of nr-axSpA remains controversial in terms of the magnetic resonance Imaging (MRI) lesions that define the presence of sacroillitis. While early studies reported that bone marrow edema and erosions were specific for nr-axSpA, subsequent work found such lesions to be present in those with mechanical causes for back pain, such as healthy athletes. Therefore, the goal of this work is to construct multivariable models predicting clinical improvement, and compare these models with novel MRI-based models clinical improvement.

The goal of this work is to improve clinical outcomes and quality of life of people with nr-axSpA, through earlier disease recognition and enhanced access to effective therapies. To this end, this application seeks to establish subject-level characteristics among nr-axSpA trial subjects who responded to Tumor necrosis factor inhibitor (TNFi) treatment or placebo. This work will leverage a unique collaboration of experts in spondyloarthritis, epidemiology and musculoskeletal imaging.

脊柱关节炎（Spondyloarthritis）是一类以脊柱炎症为特征的疾病，通常会导致活动受限与残疾。强直性脊柱炎（Ankylosing spondylitis）是该类疾病的原型亚型，其特征为X光片可见的骨质改变。然而，早期或病情较轻的患者可能仅在磁共振成像（magnetic resonance Imaging, MRI）上出现可见病变，这类疾病被称为非放射学中轴型脊柱关节炎（non-radiographic axial spondyloarthritis, nr-axSpA）。目前，nr-axSpA的分类在基于MRI病变定义骶髂炎存在与否的标准上仍存在争议。尽管早期研究认为骨髓水肿与骨质侵蚀是nr-axSpA的特异性病变，但后续研究发现这类病变也可见于存在机械性背痛病因的人群，例如健康运动员。因此，本研究旨在构建预测临床改善情况的多变量模型，并将此类模型与新型基于MRI的临床改善预测模型进行对比。

本研究的目标是通过更早的疾病识别以及让患者更便捷地获得有效治疗，改善nr-axSpA患者的临床结局与生活质量。为此，本项目旨在明确对肿瘤坏死因子抑制剂（Tumor necrosis factor inhibitor, TNFi）治疗或安慰剂产生应答的nr-axSpA临床试验受试者的个体层面特征。本研究将依托脊柱关节炎、流行病学与肌肉骨骼影像学领域专家的跨领域协作团队开展。