***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose To evaluate the efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis ( nr-axSpA ) . Methods Patients fulfilled Assessment of Spondyloarthritis international Society ( ASAS ) criteria for axial spondyloarthritis , had a Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) score of ≥ 4 , total back pain score of ≥ 4 ( 10 cm visual analogue scale ) and inadequate response , intolerance or contraindication to non-steroidal anti-inflammatory drugs ( NSAIDs ) ; patients fulfilling modified New York criteria for ankylosing spondylitis were excluded . Patients were r and omised to adalimumab ( N=91 ) or placebo ( N=94 ) . The primary endpoint was the percentage of patients achieving ASAS40 at week 12 . Efficacy assessment s included BASDAI and Ankylosing Spondylitis Disease Activity Score ( ASDAS ) . MRI was performed at baseline and week 12 and scored using the Spondyloarthritis Research Consortium of Canada ( SPARCC ) index . Results Significantly more patients in the adalimumab group achieved ASAS40 at week 12 compared with patients in the placebo group ( 36 % vs 15 % , p<0.001 ) . Significant clinical improvements based on other ASAS responses , ASDAS and BASDAI were also detected at week 12 with adalimumab treatment , as were improvements in quality of life measures . Inflammation in the spine and sacroiliac joints on MRI significantly decreased after 12 weeks of adalimumab treatment . Shorter disease duration , younger age , elevated baseline C-reactive protein or higher SPARCC MRI sacroiliac joint scores were associated with better week 12 responses to adalimumab . The safety profile was consistent with what is known for adalimumab in ankylosing spondylitis and other diseases . Conclusions In patients with nr-axSpA  , adalimumab treatment result ed in effective control of disease activity , decreased inflammation and improved quality of life  compared with placebo . Results from ABILITY-1 suggest that adalimumab has a positive benefit – risk profile in active nr-axSpA patients with inadequate response to NSAIDs OBJECTIVE To compare the performance of whole-body magnetic resonance imaging ( MRI ) versus conventional MRI in assessing acute inflammatory lesions of the sacroiliac ( SI ) joints in patients with established and active spondylarthritis ( SpA ) using the Spondyloarthritis Research Consortium of Canada ( SPARCC ) MRI index . This study is validating whole-body MRI against the current MRI st and ard for assessing active inflammatory lesions of the SI joints in patients with SpA. METHODS Thirty-two SpA patients with clinical ly active disease ( Bath Ankylosing Spondylitis Disease Activity Index score > /=4 ) fulfilling the modified New York criteria were scanned by whole-body and conventional MRI of the SI joints . The MRIs were scored independently in r and om order by 3 readers blinded to patient identity . Active inflammatory lesions of the SI joints were recorded on a Web-based SPARCC index . Pearson 's correlation coefficients were used to compare scores for whole-body and conventional MRI for each reader , whereas intraclass correlation coefficients ( ICCs ) were used to compare interobserver reliability . RESULTS The Pearson 's correlation coefficients between whole-body and conventional MRI per rater were 0.94 , 0.87 , and 0.93 . The mean sum scores for conventional versus whole-body MRI  were statistically significantly higher for all 3 readers , although all patients showing inflammatory lesions on conventional MRI also demonstrated them on whole-body MRI . The ICCs(2,1 ) were 0.69 , 0.78 , and 0.95 for conventional MRI , and 0.79 , 0.85 , and 0.96 for whole-body MRI for the 3 possible reader pairs . CONCLUSION Whole-body and conventional MRI scores show a strong correlation and comparable reliability for the detection of inflammatory lesions of the SI joints Objective : To examine the efficacy and safety of infliximab combined with methotrexate compared with methotrexate alone in the treatment of ankylosing spondylitis ( AS ) using MRI and DXA to monitor its impact on bone . Methods : In this single centre study 42 subjects with active AS were treated with methotrexate and were r and omly assigned , in a ratio of 2:1 , to receive five infusions of either 5 mg/kg infliximab or placebo over 30 weeks . The primary outcome was improvement in disease activity as shown by the BASDAI at week 30 . MRI was used to assess the effect of treatments on sacroiliac and spinal enthesitis/osteitis and DXA to monitor bone mineral density . Results : Both therapeutic agents were well tolerated with no dropouts due to adverse events . A significantly greater improvement in mean BASDAI score was seen in the infliximab arm at week 10 ( p = 0.017 ) than in the placebo arm , but this was not maintained by week 30 ( p = 0.195 ) , 8 weeks after the last infusion , at which stage disease flares were reported by some subjects . MRI showed that the mean number of lesions resolving for each subject from week 0 to week 30 was significantly greater in the combination group than in the methotrexate monotherapy group ( p = 0.016 ) . Conclusions : Infliximab in combination with methotrexate was a safe and efficacious treatment in AS over 6 months and was associated with significant regression in enthesitis/osteitis as determined by MRI . However , disease flares were reported 8 weeks after the last infusion , indicating that addition of methotrexate failed to extend the infliximab dosing interval OBJECTIVES To investigate the additional value of T1 fat-saturated after gadolinium ( T1/Gd ) compared with T1 and short tau inversion recovery ( STIR ) sequence in detecting active lesions of the SI joints typical of axial SpA ( axSpA ) in a prospect i ve cohort study , the SpondyloArthritis Caught Early ( SPACE ) cohort , and to assess its influence on final MRI diagnosis of the SI joint ( MRI-SIJ ) based on the Assessment of Spondyloarthritis International Society ( ASAS ) definition of active sacroiliitis . METHODS Patients in the SPACE cohort received baseline and 3-month follow-up MRI-SIJ with coronal oblique T1 , STIR and T1/Gd sequences .  Bone marrow oedema ( BME ) , capsulitis/enthesitis and synovitis and active sacroiliitis according to the ASAS definition were evaluated by three blinded readers . RESULTS A total of 127 patients received an MRI-SIJ  at baseline and 67 patients also received an MRI-SIJ at 3 months follow-up since the Gd protocol was added some months after the start of the SPACE project . Twenty-five of the 127 patients ( 19.7 % ) with a baseline MRI-SIJ and 14 of 67 patients ( 20.6 % ) with a follow-up MRI-SIJ presented BME on the STIR sequence sufficient to fulfill the ASAS definition for a positive MRI-SIJ . In eight patients , additional synovitis and /or capsulitis/enthesitis was observed ; however , no additional BME was visualized on T1/Gd . One patient , without clinical diagnosis of axSpA , showed synovitis as an isolated finding . CONCLUSION Synovitis and capsulitis/enthesitis are detectable with the administration of Gd . However , they are always observed in the presence of BME . Therefore T1 and STIR sequence alone are sufficient in the MRI assessment that , among others , is used for diagnosing patients with early Objective To evaluate golimumab 's effect on  MRI-detected spinal inflammation in ankylosing spondylitis ( AS ) . Methods Patients were r and omly assigned to subcutaneous injections of placebo ( n=78 ) , golimumab 50 mg ( n=138 ) , or golimumab 100 mg ( n=140 ) every 4 weeks . An MRI sub study comprising 98 patients ( placebo n=23 , 50 mg n=37 , 100 mg n=38 ) at eligible MRI sub study sites had serial spine MRI scans ( sagittal plane , 1.5 T scanners , T1 and short tau inversion recovery sequences ) at baseline and weeks 14 and 104 . Two blinded ( treatment , image order ) readers independently evaluated MRI spinal inflammation using AS spine MRI-activity ( ASspiMRI-a ) scores ; reader scores were averaged . Changes from baseline to weeks 14 and 104 were compared among treatment groups using analysis of variance on van der Waerden normal scores both with ( post-hoc ) and without ( prespecified ) adjustment for baseline ASspiMRI-a scores . Results Median baseline ASspiMRI-a scores were lower in the 100 mg ( 3.5 ) than placebo ( 6.8 ) and 50 mg ( 7.8 ) groups . Median decreases in activity scores from baseline to week 14 were −0.5 for placebo , −3.5 for 50 mg ( p=0.047 vs placebo ) , and −1.5 for 100 mg ( p=0.14 vs placebo ) . After adjusting for baseline ASspiMRI-a score imbalance , significant improvements were observed with both 50 mg ( p=0.011 ) and 100 mg ( p=0.002 ) versus placebo . ASspiMRI-a scores improvement achieved with golimumab was maintained at week 104 . Improvement in ASspiMRI-a scores correlated with improvement in the recently developed AS disease activity score ( ASDAS ) and C-reactive protein ( CRP ) levels but not with other key AS clinical outcomes . Conclusion Golimumab significantly reduced MRI-detected spinal inflammation of AS ; improvements were sustained to week 104 and correlated with improvement in ASDAS and CRP A system of classification criteria of spondyloarthropathies  was experimented in three studies . They have permitted to measure its specificity which is 86.6 p. cent and its sensitivity which is 90 p. cent . This system permits to compare theory and clinical practice and also to classify disease not yet classified . The positive and negative predictive values of these tests remain to be vali date d and assessed , with a multicenter study including patients affected or not with spondyloarthropathy , in order to determine whether they can also be used as a diagnosis tool Objective To investigate the relationship between MRI inflammation at the vertebral unit and the formation and growth of syndesmophytes at the same vertebral unit . Methods An 80 % r and om sample of the ASSERT data base was analysed . MRI were scored using the ankylosing spondylitis ( AS ) spinal MRI activity score ( at baseline , 24 and 102 weeks ) and spinal x-rays were scored using the modified Stoke AS spine score ( at baseline and 102 weeks ) . Data were analysed at the patient level and the vertebral unit level using a multilevel approach to adjust for within-patient correlation . Results There was a slightly increased probability of developing syndesmophytes in vertebral units with MRI activity , which was maintained after adjustment for within-patient correlation ( per vertebral unit level ) and treatment , and after further adjustment for potential confounders , result ing in significant OR ranging from 1.51 to 2.26 . Growth of existing syndesmophytes at the vertebral unit level was not associated with MRI activity . At the patient level only a trend for an association was observed . Conclusion MRI inflammation in a vertebral unit slightly increases the propensity to form a new syndesmophyte in the same vertebral unit , but does not predict the growth of already existing syndesmophytes . Despite this association , the large majority of new syndesmophytes developed in vertebral units without inflammation . The subtle association at the vertebral unit level did not translate into an association at the patient level Objective : To vali date and refine two sets of c and i date criteria for the classification/diagnosis of axial spondyloarthritis ( SpA ) . Methods : All Assessment of SpondyloArthritis international Society ( ASAS ) members were invited to include consecutively new patients with chronic ( ⩾3 months ) back pain of unknown origin that began before 45 years of age . The c and i date criteria were first tested in the entire cohort of 649 patients from 25 centres , and then refined in a r and om selection of 40 % of cases and thereafter vali date d in the remaining 60 % . Results : Upon diagnostic work-up , axial SpA was diagnosed in 60.2 % of the cohort . Of these , 70 % did not fulfil modified New York criteria and , therefore , were classified as having “ non-radiographic ” axial SpA. Refinement of the c and i date criteria result ed in new ASAS classification criteria that are defined as : the presence of sacroiliitis by radiography or by magnetic resonance imaging ( MRI ) plus at least one SpA feature ( “ imaging arm ” ) or the presence of HLA-B27 plus at least two SpA features ( “ clinical arm ” ) . The sensitivity and specificity of the entire set of the new criteria were 82.9 % and 84.4 % , and for the imaging arm alone 66.2 % and 97.3 % , respectively . The specificity of the new criteria was much better than that of the European Spondylarthropathy Study Group criteria modified for MRI ( sensitivity 85.1 % , 
    Output:
    
These are the first recommendations which encompass the entire spectrum of SpA and evaluate the full role of all commonly used imaging modalities .