Clinical and MRI features associated with remission following biological therapy in axial spondyloarthritis
4 affiliations
- 1Arthritis Unit, Rheumatology Department, Hospital Clínic, Villarroel, Barcelona, 170, 08036 Spain
- 2Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- 3Radiology Department, Musculoskeletal Unit, Hospital Clínic, Barcelona, Spain
- 4University of Barcelona, Barcelona, Spain
Abstract
Objective: To evaluate clinical and MRI features associated with clinical response in patients with axial spondyloarthritis (axSpA) initiating biological therapy.
Methods: Forty-one biologic-naïve axSpA patients underwent baseline sacroiliac joint MRI before starting biological therapy. Clinical, inflammatory markers, disease activity scores, and MRI data (SPARCC score) were collected. Outcomes included clinical responses according to BASDAI and ASDAS.
Results: Twenty-two were women (53.7%), with a median age of 40 years (IQR 34–55) and a median disease duration of 96 months (IQR 60–144). A total of 74.4% were HLA-B27 positive and all of them were clinically active, with median BASDAI and ASDAS-CRP scores prior to MRI of 6.4 (IQR 5.30–7.15) and 3.4 (IQR 2.98–4.03), respectively. At 16 weeks, 52.4% achieved BASDAI remission, which was independently associated with higher iliac erosion (OR 1.1, p 0.029). Clinically important ASDAS improvement occurred in 71.4% of patients and was significantly associated with higher baseline CRP (p 0.011). Major ASDAS improvement was linked to higher initial disease activity and iliac erosion scores, though not independently after adjustment. A combined baseline MRI score (bone edema + erosion) was significantly associated with achieving ASDAS inactive disease (AUC 0.74); No MRI or clinical variables retained independent predictive value in adjusted models.
Conclusion: Higher iliac erosion scores are independently associated with BASDAI remission after biologic therapy in axSpA. A combined MRI inflammation and structural damage score may help predict ASDAS inactive disease. These findings highlight the value of MRI for identifying patients more likely to benefit from biologic therapy intervention. Key Points
∙ Baseline MRI-detected iliac erosions identify patients more likely to achieve BASDAI remission after initiation of biologic therapy in axSpA.
∙ Patients achieving rapid and deep clinical responses show higher baseline MRI scores reflecting both active inflammation (BME) and established structural damage (iliac erosions).
∙ A combined MRI score integrating bone marrow edema and erosions improves prediction of ASDAS inactive disease, supporting the value of assessment of both inflammation and structural damage.
Related
- Immunogenicity, Safety, and Clinical Outcomes Following Homologous and Heterologous SARS-CoV-2 Vaccination Regimens in Patients with Axial Spondyloarthritis and Psoriatic Arthritis: A Prospective Observational Study from the SAFER Cohort.
- Clinical Factors and Cumulative Smoking Burden Associated with Anti-TNF Switching in Radiographic Axial Spondyloarthritis: A Real-World Cohort Study
- Clinical Factors Associated with Diagnostic Delay in Axial Spondyloarthritis in Saudi Arabia: A Retrospective Cohort Study.
- Clinical remission and associated factors in severe eosinophilic asthma patients treated with benralizumab: a real-world study
- Biological aging measured from electronic health records is associated with recovery following cardiothoracic surgery
BibTeX
@article{azuaga2026clinical,
title = {{Clinical and MRI features associated with remission following biological therapy in axial spondyloarthritis}},
author = {Ana Belén Azuaga and Ana Isabel García-Díez and Claudia Arango and Jaime Isern-Kebschull and Beatriz Frade-Sosa and Juan C Sarmiento-Monroy and Marina Urbano and Juan D Cañete and Julio Ramírez},
journal = {Clinical Rheumatology},
year = {2026},
month = sep,
doi = {10.1007/s10067-026-08380-9},
url = {https://doi.org/10.1007/s10067-026-08380-9},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical and MRI features associated with remission following biological therapy in axial spondyloarthritis
AU - Ana Belén Azuaga
AU - Ana Isabel García-Díez
AU - Claudia Arango
AU - Jaime Isern-Kebschull
AU - Beatriz Frade-Sosa
AU - Juan C Sarmiento-Monroy
AU - Marina Urbano
AU - Juan D Cañete
AU - Julio Ramírez
PY - 2026
DA - 2026/09/11
JO - Clinical Rheumatology
DO - 10.1007/s10067-026-08380-9
UR - https://doi.org/10.1007/s10067-026-08380-9
AB - Objective: To evaluate clinical and MRI features associated with clinical response in patients with axial spondyloarthritis (axSpA) initiating biological therapy. Methods: Forty-one biologic-naïve axSpA patients underwent baseline sacroiliac joint MRI before starting biological therapy. Clinical, inflammatory markers, disease activity scores, and MRI data (SPARCC score) were collected. Outcomes included clinical responses according to BASDAI and ASDAS. Results: Twenty-two were women (53.7%), with a median age of 40 years (IQR 34–55) and a median disease duration of 96 months (IQR 60–144). A total of 74.4% were HLA-B27 positive and all of them were clinically active, with median BASDAI and ASDAS-CRP scores prior to MRI of 6.4 (IQR 5.30–7.15) and 3.4 (IQR 2.98–4.03), respectively. At 16 weeks, 52.4% achieved BASDAI remission, which was independently associated with higher iliac erosion (OR 1.1, p 0.029). Clinically important ASDAS improvement occurred in 71.4% of patients and was significantly associated with higher baseline CRP (p 0.011). Major ASDAS improvement was linked to higher initial disease activity and iliac erosion scores, though not independently after adjustment. A combined baseline MRI score (bone edema + erosion) was significantly associated with achieving ASDAS inactive disease (AUC 0.74); No MRI or clinical variables retained independent predictive value in adjusted models. Conclusion: Higher iliac erosion scores are independently associated with BASDAI remission after biologic therapy in axSpA. A combined MRI inflammation and structural damage score may help predict ASDAS inactive disease. These findings highlight the value of MRI for identifying patients more likely to benefit from biologic therapy intervention. Key Points ∙ Baseline MRI-detected iliac erosions identify patients more likely to achieve BASDAI remission after initiation of biologic therapy in axSpA. ∙ Patients achieving rapid and deep clinical responses show higher baseline MRI scores reflecting both active inflammation (BME) and established structural damage (iliac erosions). ∙ A combined MRI score integrating bone marrow edema and erosions improves prediction of ASDAS inactive disease, supporting the value of assessment of both inflammation and structural damage.
SN - 0770-3198
SN - 1434-9949
ER -