ArticleArthritis & rheumatology (Hoboken, N.J.)2021
Tumor Necrosis Factor Inhibitors Reduce Spinal Radiographic Progression in Patients With Radiographic Axial Spondyloarthritis: A Longitudinal Analysis From the Alberta Prospective Cohort.
Article in Arthritis & rheumatology (Hoboken, N.J.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 40 citations in OpenAlex.
- Comparison of the effect of treatment with NSAIDs added to anti-TNF therapy versus anti-TNF therapy alone on the progression of structural damage in the spine over 2 years in patients with radiographic axial spondyloarthritis from the randomised-controlled CONSUL trial.Annals of the rheumatic diseases · 2024Trial
- Therapeutics in Axial Spondyloarthritis: A Review of What Works - SPARTAN 2026 Annual Meeting Proceedings.Current rheumatology reports · 2026Review
- In search of a window of opportunity in axial spondyloarthritis: treatment outcomes across different symptom durations.EULAR rheumatology open · 2026Article
- Observational
- Age-related prevalence of sacroiliac joint variations and their association with structural damage in axial spondyloarthritis.BMC musculoskeletal disorders · 2026Article
- Association between cumulative TNF inhibitor dose and spinal radiographic progression in radiographic axial spondyloarthritis in patients with modified stoke ankylosing spondylitis spinal score ⩽24.Therapeutic advances in musculoskeletal disease · 2025Article
- Beyond inflammation: the molecular basis of bone remodeling in axial spondyloarthritis and psoriatic arthritis.Frontiers in immunology · 2025Review
- Angiotensin receptor blockers, but not angiotensin-converting enzyme inhibitors, inhibit abnormal bone changes in spondyloarthritis.Experimental & molecular medicine · 2023Article
- Biomechanics in the onset and severity of spondyloarthritis: a force to be reckoned with.RMD open · 2023Review
- Tofacitinib Reduces Spinal Inflammation in Vertebral Bodies and Posterolateral Elements in Ankylosing Spondylitis: Results from a Phase 2 Trial.Rheumatology and therapy · 2023Article
- Syndesmophyte Growth in Ankylosing Spondylitis: from Laboratory to Bedside.Current rheumatology reports · 2023Review
- Association between changes in serum alkaline phosphatase levels and radiographic progression in ankylosing spondylitis.Scientific reports · 2023Article
- Sustained low functional impairment in axial spondyloarthritis (axSpA): which are the primary outcomes that should be targeted to achieve this?Arthritis research & therapy · 2023Article
- Quantitative prediction of radiographic progression in patients with axial spondyloarthritis using neural network model in a real-world setting.Arthritis research & therapy · 2023Article
- Uncovering the Underworld of Axial Spondyloarthritis.International journal of molecular sciences · 2023Review
- Article
- Bone Involvement in Patients with Spondyloarthropathies.Calcified tissue international · 2022Review
- Sustained low disease activity measured by ASDAS slow radiographic spinal progression in axial spondyloarthritis patients treated with TNF-inhibitors: data from REGISPONSERBIO.Arthritis research & therapy · 2022Article
- New developments in ankylosing spondylitis-status in 2021.Rheumatology (Oxford, England) · 2021Article
- Biological DMARDs and disease modification in axial spondyloarthritis: a review through the lens of causal inference.RMD open · 2021Review
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate whether tumor necrosis factor inhibitors (TNFi) impact spinal radiographic progression in patients with axial spondyloarthritis (SpA) and whether this is coupled to their effect on inflammation.
methodsPatients with axial SpA fulfilling the modified New York criteria were included in a prospective cohort (the ALBERTA Follow Up Research Cohort in Ankylosing Spondylitis Treatment). Spine radiographs, performed every 2 years for up to 10 years, were scored by 2 central readers, using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The indirect effect of TNFi on mSASSS was evaluated with generalized estimating equations by testing the interaction between TNFi and Ankylosing Spondylitis Disease Activity Score (ASDAS) at the start of each 2-year interval (t). If significant, the association between ASDAS at t and mSASSS at the end of the interval (t+1) was assessed in 1) patients treated with TNFi at all visits, 2) patients treated with TNFi at some visits, and 3) patients who were never treated with TNFi. In addition, the association between TNFi at t and mSASSS at t+1 (adjusting for ASDAS at t) was also tested (direct effect).
resultsIn total, 314 patients were included. A gradient was seen for the effect of ASDAS at t on mSASSS at t+1 (interaction P = 0.10), with a higher progression in patients never treated with TNFi (β = 0.41 [95% confidence interval (95% CI) 0.13, 0.68]) compared to those continuously treated (β = 0.16 [95% CI 0.00, 0.31]) (indirect effect). However, TNFi also directly slowed progression, as treated patients had on average an mSASSS 0.85 units lower at t+1 compared to untreated patients (β = -0.85 [95% CI -1.35, -0.35]).
conclusionOur findings indicate that TNFi reduce spinal radiographic progression in patients with radiographic axial SpA, which might be partially uncoupled from their effects on inflammation as measured by the ASDAS.
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