Background: Sacroiliac bone marrow edema is an important factor in the diagnosis and management of axial spondyloarthritis (axSpA).

Objectives: The aim of this meta-analysis is to assess the effect of the different bDMARDs and tsDMARDs on the SPARCC score at 12-16 and 48-52 weeks.

Methods: A systematic review, performed on Pubmed, Embase and Cochrane databases, included randomized controlled studies evaluating the sacroiliac joint (SIJ) SPARCC score at 12-16 or 48-52 weeks in patients with axSpA meeting the ASAS 2009 criteria or the modified New York criteria. We included studies evaluating the effects of the different treatments on the SPARCC score of SIJ in axial spondyloarthritis in comparison to a control group.

Results: Fifteen studies were included in the meta-analysis. Nine studies evaluated the effect of TNF inhibitors (TNFi), two for ixekizumab, one for filgotinib and one for tofacitinib. At 12 and 16 weeks, SIJ SPARCC score was significantly improved by TNFi (WMD: - 3.29 [95% CI -4.25; -2, 34]), IL-17 inhibitors (WMD: - 3.98 [95% CI –5.76; -2.20]) and by JAK inhibitors (JAKi) (WMD: - 3.02 [95% CI -4.54; -1.51]). There was no difference between the molecule subgroups. At 48-52 weeks, TNFα inhibitors, introduced at baseline, reduced more SIJ SPARCC, but not significantly (WMD: -2.26 [95% CI -4.94; 0.42]), than placebo groups who began a TNFi treatment with delay.

Conclusion: Our meta-analysis shows a comparable improvement of the SIJ SPARCC score regarding TNFi, JAKi and IL-17 inhibitors at three months and suggests the presence of an opportunity window.

Figure 1.

Forest plot of SPARCC SIJ score for all therapeutic agents versus controls at week 12-16.

Disclosure of Interests: None declared