{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:59:52Z","timestamp":1753891192066,"version":"3.41.2"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T00:00:00Z","timestamp":1638835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> In the clinic, some patients with axial spondyloarthritis (axSpA) have to reduce tumor necrosis factor inhibitor (TNFi) for various reasons. However, there are few studies about how to balance the relapse and TNFi reduction. Here we retrospectively analyzed the structural progression of the sacroiliac joint (SIJ) and clinical features in axSpA during TNFi reduction.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A total of 108 patients with axSpA who followed up for 2 years and completed at least baseline, 12-month, and 24-month MRI scans of SIJ were divided into the tapering group (<jats:italic>n<\/jats:italic> = 63) and withdrawal group (<jats:italic>n<\/jats:italic> = 45) according to whether TNFi was stopped. We divided 2 years into five intervals, calculating the average dose quotient (DQ) for each of 540 intervals from 108 patients. By using generalized estimation equations with inverse probability of treatment weighting, we investigated the unbiased effects of average DQ on structural progression and treatment response.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The disease activity (such as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, and ASDAS-ESR) and relapse rate were lower in the tapering group at 12 and 24 months (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). \u0394erosion (\u03b2 = \u22120.0100, <jats:italic>p<\/jats:italic> = 0.00026) and \u0394the Spondyloarthritis Research Consortium of Canada (SPARCC; \u03b2 = \u22120.0959, <jats:italic>p<\/jats:italic> &amp;lt; 0.0001) were negatively correlated with average DQ. The average DQ 30 (74.8%, 80.0%) or 41.6 (76.5%, 83%) was best to discriminate the status of treatment response or the status of bone marrow edema, but considering operability, the average DQ 25 (78.0%, 63.3%) was also acceptable especially for patients with HLA-B27 negative and non-severe fat metaplasia.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Complete TNFi withdrawal was not recommended. Our study provided a referable strategy (tapering then maintained the average DQ over 30 or even 25) for patients who need TNFi reduction. Higher dose usage of TNFi was associated with a slower erosion progression of SIJ.<\/jats:p>","DOI":"10.3389\/fmed.2021.781088","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T10:22:55Z","timestamp":1638872575000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Structural Lesion Progression of the Sacroiliac Joint and Clinical Features in axSpA During TNFi Reduction: A Retrospective Cohort Study"],"prefix":"10.3389","volume":"8","author":[{"given":"Qian","family":"Mo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanji","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cong","family":"Ye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jixin","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaozhe","family":"Cai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lingli","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/s0140-6736(16)31591-4","article-title":"Axial spondyloarthritis","volume":"390","author":"Sieper","year":"2017","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1136\/annrheumdis-2016-210770","article-title":"2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis","volume":"76","author":"Van Der Heijde","year":"2017","journal-title":"Ann Rheum Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1136\/annrheumdis-2017-211734","article-title":"Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force","volume":"77","author":"Smolen","year":"2018","journal-title":"Ann Rheum Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1016\/j.semarthrit.2014.10.009","article-title":"The burden of non-radiographic axial spondyloarthritis","volume":"44","author":"Boonen","year":"2015","journal-title":"Semin Arthritis Rheum."},{"key":"B5","first-page":"S16","article-title":"Mortality, course of disease and prognosis of patients with ankylosing spondylitis","volume":"20","author":"Braun","year":"2002","journal-title":"Clin Exp Rheumatol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1002\/acr.22730","article-title":"Work outcome in patients with ankylosing spondylitis: results from a 12-year followup of an international study","volume":"68","author":"Castillo-Ortiz","year":"2016","journal-title":"Arthritis Care Res (Hoboken)."},{"key":"B7","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1136\/ard.2009.108233","article-title":"The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection","volume":"68","author":"Rudwaleit","year":"2009","journal-title":"Ann Rheum Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1002\/art.1780270401","article-title":"Evaluation of diagnostic criteria for ankylosing spondylitis. 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