Objective. Ankylosing spondylitis (AS) is diagnosed late, because radiographs of the sacroiliac joints often do not show definite sacroiliitis at the time of disease onset. The aim of this study was to investigate whether patients without definite radiographically defined sacroiliitis, referred to as nonradiographic axial spondylarthritis (SpA), are different from patients with AS with regard to clinical manifestations and disease activity measures. Moreover, we sought to identify determinants of the development of radiographic sacroiliitis.Methods. In a cross-sectional analysis of 462 patients, we compared 226 patients with nonradiographic axial SpA (symptom duration <5 years) and 236 patients with AS (symptom duration <10 years) who are participants in the German Spondyloarthritis Inception Cohort. Radiographs of the sacroiliac joints and the spine were assessed by 2 readers in a blinded manner. Logistic regression analysis was applied to identify parameters associated with structural damage.Results. The 2 groups did not differ in the frequency of HLA-B27 positivity, inflammatory back pain, arthritis, enthesitis, and uveitis and had similar levels of disease activity, using measures such as the Bath Ankylosing Spondylitis Disease Activity Index. In both groups, HLA-B27 positivity determined the age at disease onset. Conclusion. Clinical manifestations and disease activity measures are highly comparable between patients with early nonradiographic axial SpA and those with early AS, suggesting that these 2 entities are part of the same disease. Male sex and an elevated CRP level are associated with structural damage on radiographs, whereas HLA-B27 positivity determines the age at disease onset.

Objective. To assess prospectively the rates and to explore predictors of spinal radiographic progression over 2 years in a cohort of patients with early axial spondylarthritis (SpA).Methods. Two hundred ten patients with axial SpA from the German Spondyloarthritis Inception Cohort were selected for this analysis based on the availability of radiographs at baseline and after 2 years of followup. Spinal radiographs were scored by 2 trained readers in a blinded, randomly selected order according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Spinal radiographic progression was defined as worsening of the mean mSASSS by >2 units over 2 years.Results. Among the patients with axial SpA, 14.3% showed spinal radiographic progression after 2 years (20% of those with AS and 7.4% of those with nonradiographic axial SpA). The following parameters were independently associated with spinal radiographic progression: presence of syndesmophytes at baseline (odds ratio [OR] 6.29, P < 0.001), elevated levels of markers of systemic inflammation (for the erythrocyte sedimentation rate, OR 4.04, P ‫؍‬ 0.001; for C-reactive protein level time-averaged over 2 years, OR 3.81, P ‫؍‬ 0.001), and cigarette smoking (OR 2.75, P ‫؍‬ 0.012). These associations were confirmed by multivariate logistic regression analysis. No clear association with spinal radiographic progression was observed for HLA-B27 status, sex, age, disease duration, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, presence of peripheral arthritis, enthesitis, psoriasis, treatment with nonsteroidal antiinflammatory drugs, or treatment with disease-modifying antirheumatic drugs at baseline.Conclusion. The presence of radiographic damage at baseline (syndesmophytes), elevated levels of acutephase reactants, and cigarette smoking were all independently associated with spinal radiographic progression in patients with early axial SpA.The term axial spondylarthritis (SpA) refers to patients with radiographic sacroiliitis fulfilling the modified New York criteria for ankylosing spondylitis (AS) (1) and patients with nonradiographic axial SpA (i.e., patients without definite radiographic changes in the sacroiliac joints) (2).

Progression of radiographic sacroiliitis by at least one grade after 2 years occurs only in a small percentage of patients with early axial spondyloarthritis. An elevated level of CRP was found to be a strong positive predictor of sacroiliitis progression.

radiographic progression in the spine over 2 years as compared with on-demand use. 3 However, these reports have not been confi rmed until now. Furthermore, NSAIDs infl uence on radiographic progression in early axial SpA (especially in a nonradiographic form) was not investigated so far. This analysis of the 2-year data from the German Spondyloarthritis Inception Cohort (GESPIC) was aimed at investigating the infl uence of NSAIDs intake on radiographic progression of the spine in patients with AS and non-radiographic axial SpA with short disease duration. METHODS Patient selectionPatients included in GESPIC were required to have a defi nite clinical diagnosis of axial SpA according to the local rheumatologist. Patients were further classifi ed based on radiographic fi ndings as AS or as non-radiographic axial SpA. Patients with AS ought to fulfi l the modifi ed New York criteria 4 and the duration of symptoms was restricted to ≤10 years at the time of inclusion. Patients with nonradiographic axial SpA ought to fulfi l European Spondyloarthropathy Study Group criteria 5 with minor modifi cations 6 and had to have duration of symptoms of ≤5 years. The baseline data of this cohort have been recently reported elsewhere. 6 Radiographs of the spine (lumbar and cervical spine) and sacroiliac joints were obtained at baseline and after 2 years of follow-up. The full sets of radiographs were available for 210 GESPIC patients (115 with AS and 95 with non-radiographic axial SpA) as reported elsewhere. 7 Of these, information on NSAIDs intake over 2 years was available for 164 patients (88 with AS and 76 with non-radiographic axial SpA) who were naïve to antitumour necrosis factor (TNF) therapy and did not receive this therapy during 2 years of follow-up. Radiographs and scoringX-rays of sacroiliac joints and spine (cervical and lumbar spine at baseline and after 2 years of follow-up) were performed locally. Images were centrally collected, digitised, anonymised and subsequently scored independently by two trained readers (DP, HH). The readers scored radiographs in a concealed and randomly selected order and ABSTRACTObjective To investigate the infl uence of non-steroidal anti-infl ammatory drugs (NSAIDs) intake on radiographic spinal progression over 2 years in patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (SpA). Methods 164 patients with axial SpA (88 with AS and 76 with non-radiographic axial SpA) were selected for this analysis based on availability of spinal radiographs at baseline and after 2 years of follow-up and the data on NSAIDs intake. Spinal radiographs were scored by two trained readers in a concealed randomly selected order according to the modifi ed Stoke Ankylosing Spondylitis Spine Score (mSASSS) system. An index of the NSAID intake counting both dose and duration of drug intake was calculated. Results High NSAIDs intake (NSAID index≥50) in AS was associated with lower likelihood of signifi cant radiographic progression defi ned as an mSASSS worsening by ≥2 units: ...

Tumor necrosis factor-alpha is considered to be one of the important mediators in the pathogenesis of psoriasis. A strong association of juvenile onset psoriasis with the major histocompatibility complex encoded HLA-Cw6 antigen has been reported but it is unclear whether Cw6 itself or a closely linked gene is involved in the pathogenesis. This study has focused on the association of promoter polymorphisms of the major histocompatibility complex encoded tumor necrosis factor-alpha gene with psoriasis and psoriatic arthritis. Tumor necrosis factor-alpha promoter polymorphisms were sought by sequence-specific oligonucleotide hybridization and by direct sequencing in Caucasian patients with juvenile onset psoriasis and with psoriatic arthritis and in healthy controls. A mutation at position -238 of the tumor necrosis factor-alpha promoter was present in 23 of 60 patients (38%; p < 0.0001; p[corr] < 0.008) with juvenile onset psoriasis and in 20 of 62 patients (32%; p < 0.0003; p[corr] < 0.03) with psoriatic arthritis, compared with seven of 99 (7%) Caucasian controls. There was a marked increase of homozygotes for this mutation in the psoriasis group. Another mutation at position -308 was found in similar proportions of patients and controls. Our study shows a strong association of the tumor necrosis factor-alpha promoter polymorphism at position -238 with psoriasis and psoriatic arthritis. Our findings suggest that this promoter polymorphism itself or a gene in linkage disequilibrium with tumor necrosis factor-alpha predispose to the development of psoriasis.