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Spinal radiographic progression in patients with ankylosing spondylitis treated with TNF-α blocking therapy: a prospective longitudinal observational cohort study.

Maas F, Spoorenberg A, Brouwer E, Bos R, Efde M, Chaudhry RN, Veeger NJ, van Ooijen PM, Wolf R, Bootsma H, van der Veer E, Arends S - PLoS ONE (2015)

Bottom Line: Radiographs were scored by two independent readers using the modified Stoke AS Spine Score (mSASSS).Median mSASSS increased significantly from 10.7 (IQR: 4.6-24.0) at baseline to 14.8 (IQR: 7.9-32.8) at 6 years.Male gender, older age, longer disease duration, higher BMI, longer smoking duration, high CRP, and high ASDAS were significantly associated with syndesmophytes at baseline.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

ABSTRACT

Objectives: To evaluate spinal radiographic damage over time and to explore the associations of radiographic progression with patient characteristics and clinical assessments including disease activity in ankylosing spondylitis (AS) patients treated with tumor necrosis factor-alpha (TNF-α) blocking therapy in daily clinical practice.

Methods: Consecutive outpatients from the Groningen Leeuwarden AS (GLAS) cohort were included based on the availability of cervical and lumbar radiographs before start of TNF-α blocking therapy and after 2, 4, and/or 6 years of follow-up. Clinical data were assessed at the same time points. Radiographs were scored by two independent readers using the modified Stoke AS Spine Score (mSASSS). Spinal radiographic progression in relation to clinical assessments was analyzed using generalized estimating equations.

Results: 176 AS patients were included, 58% had syndesmophytes at baseline. Median mSASSS increased significantly from 10.7 (IQR: 4.6-24.0) at baseline to 14.8 (IQR: 7.9-32.8) at 6 years. At the group level, spinal radiographic progression was linear with a mean progression rate of 1.3 mSASSS units per 2 years. Both spinal radiographic damage at baseline and radiographic progression were highly variable between AS patients. Male gender, older age, longer disease duration, higher BMI, longer smoking duration, high CRP, and high ASDAS were significantly associated with syndesmophytes at baseline. Significantly more radiographic progression was seen in patients with versus without syndesmophytes (2.0 vs. 0.5 mSASSS units per 2 years) and in patients >40 versus ≤40 years of age (1.8 vs. 0.7 mSASSS units per 2 years). No longitudinal associations between radiographic progression and clinical assessments were found.

Conclusions: This prospective longitudinal observational cohort study in daily clinical practice shows overall slow and linear spinal radiographic progression in AS patients treated with TNF-α blocking therapy. At the individual level, progression was highly variable. Patients with syndesmophytes at baseline showed a 4-fold higher radiographic progression rate than patients without syndesmophytes.

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Flowchart of AS patients included in the analysis.
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pone.0122693.g001: Flowchart of AS patients included in the analysis.

Mentions: In total, 176 of the 267 AS patients who started with TNF-α blocking therapy between November 2004 and October 2011 were included in the analysis (Fig 1). Baseline characteristics of included patients were comparable to those who were excluded because of missing radiographs (n = 78) or >3 missing vertebral edges (n = 5) at baseline or at follow-up, except for symptom duration (median 14 vs. 17 years, p<0.05). Eight patients were excluded because of complete spinal ankylosis at baseline. These patients were older (mean 55 vs. 42 years, p<0.01) and had longer symptom duration (median 38 vs. 14 years, p<0.01).


Spinal radiographic progression in patients with ankylosing spondylitis treated with TNF-α blocking therapy: a prospective longitudinal observational cohort study.

Maas F, Spoorenberg A, Brouwer E, Bos R, Efde M, Chaudhry RN, Veeger NJ, van Ooijen PM, Wolf R, Bootsma H, van der Veer E, Arends S - PLoS ONE (2015)

Flowchart of AS patients included in the analysis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400173&req=5

pone.0122693.g001: Flowchart of AS patients included in the analysis.
Mentions: In total, 176 of the 267 AS patients who started with TNF-α blocking therapy between November 2004 and October 2011 were included in the analysis (Fig 1). Baseline characteristics of included patients were comparable to those who were excluded because of missing radiographs (n = 78) or >3 missing vertebral edges (n = 5) at baseline or at follow-up, except for symptom duration (median 14 vs. 17 years, p<0.05). Eight patients were excluded because of complete spinal ankylosis at baseline. These patients were older (mean 55 vs. 42 years, p<0.01) and had longer symptom duration (median 38 vs. 14 years, p<0.01).

Bottom Line: Radiographs were scored by two independent readers using the modified Stoke AS Spine Score (mSASSS).Median mSASSS increased significantly from 10.7 (IQR: 4.6-24.0) at baseline to 14.8 (IQR: 7.9-32.8) at 6 years.Male gender, older age, longer disease duration, higher BMI, longer smoking duration, high CRP, and high ASDAS were significantly associated with syndesmophytes at baseline.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

ABSTRACT

Objectives: To evaluate spinal radiographic damage over time and to explore the associations of radiographic progression with patient characteristics and clinical assessments including disease activity in ankylosing spondylitis (AS) patients treated with tumor necrosis factor-alpha (TNF-α) blocking therapy in daily clinical practice.

Methods: Consecutive outpatients from the Groningen Leeuwarden AS (GLAS) cohort were included based on the availability of cervical and lumbar radiographs before start of TNF-α blocking therapy and after 2, 4, and/or 6 years of follow-up. Clinical data were assessed at the same time points. Radiographs were scored by two independent readers using the modified Stoke AS Spine Score (mSASSS). Spinal radiographic progression in relation to clinical assessments was analyzed using generalized estimating equations.

Results: 176 AS patients were included, 58% had syndesmophytes at baseline. Median mSASSS increased significantly from 10.7 (IQR: 4.6-24.0) at baseline to 14.8 (IQR: 7.9-32.8) at 6 years. At the group level, spinal radiographic progression was linear with a mean progression rate of 1.3 mSASSS units per 2 years. Both spinal radiographic damage at baseline and radiographic progression were highly variable between AS patients. Male gender, older age, longer disease duration, higher BMI, longer smoking duration, high CRP, and high ASDAS were significantly associated with syndesmophytes at baseline. Significantly more radiographic progression was seen in patients with versus without syndesmophytes (2.0 vs. 0.5 mSASSS units per 2 years) and in patients >40 versus ≤40 years of age (1.8 vs. 0.7 mSASSS units per 2 years). No longitudinal associations between radiographic progression and clinical assessments were found.

Conclusions: This prospective longitudinal observational cohort study in daily clinical practice shows overall slow and linear spinal radiographic progression in AS patients treated with TNF-α blocking therapy. At the individual level, progression was highly variable. Patients with syndesmophytes at baseline showed a 4-fold higher radiographic progression rate than patients without syndesmophytes.

Show MeSH
Related in: MedlinePlus