BackgroundThe Ankylosing Spondylitis Registry of Ireland (ASRI) is a web-based database established in 2013, the objectives of which are to provide descriptive epidemiological data on the ankylosing spondylitis (AS) population in Ireland and to establish a registry for potential future studies of genetics, aetiology and therapeutics. The prevalence of osteoporosis is higher in AS patients than age- and sex-matched controls, with potential for vertebral fractures increased. However, the true prevalence is unknown. There is no data on the prevalence of osteoporosis in an Irish cohort.ObjectivesTo determine the prevalence of low bone mineral density (BMD) in an Irish AS cohort.MethodsA standardised detailed clinical assessment was performed on each patient. Disease activity was assessed by Bath AS Disease Activity Index (BASDAI), function by the Bath AS Functional Index (BASFI) and Health Assessment Questionnaire (HAQ) and quality of life by AS Quality of Life (ASQoL). Structured interviews provided patient-reported data. Presence or absence of dual-energy x-ray absorptiometry (DXA) testing and result was recorded. Bone mineral density (BMD) was categorised according to the World Health Organisation criteria into normal BMD, osteopenia or osteoporosis. Statistical analysis was performed using SPSS.ResultsAs of October 2015, 416 patients are enrolled in ASRI: 78.1% males, mean age 47.95 (SD 12.4), mean disease duration 20.9 years (SD 12.2), average delay to diagnosis of 8.8 years (SD 8.3). Mean BASDAI is 3.8 (SD 2.5), BASFI 3.7 (SD 2.7), HAQ 0.53 (SD 0.51) and ASQoL 6.15 (SD 5.5). DXAs have been performed in 24.75% (n=103) of the cohort, of which 39.8% (n=41) have osteopenia and 10.7% (n=11) have osteoporosis. Low BMD is significantly correlated with men and advancing age. There is no association with disease activity or duration. Low BMD is more prevalent in patients treated with one or more biologics compared to those never treated. The self-reported prevalence of osteoporosis is 6.4% (n=27; 19 males).ConclusionsThere is an elevated prevalence of low BMD in this cohort, with no association with disease severity. The majority of affected patients were unaware, as demonstrated by the low self-reported prevalence. More research and education is needed.Disclosure of InterestNone declared
BackgroundAxial spondyloarthropathy (axSpA) is a chronic inflammatory arthritis affecting the sacroiliac joints and spine. The consequence of inflammation in axSpA is new bone formation, or syndesmophytes, which can result in complete ankylosis of the spine. The pathogenesis of syndesmophyte formation is incompletely understood. It is agreed that presence of baseline syndesmophytes predicts further syndesmophytes, but other predictive factors have been difficult to define. In particular, the impact of extra-articular manifestations (EAMs) on syndesmophyte formation is unclear.Objectives1. To assess the burden of radiographic disease in a well-characterised axSpA cohort.2. To investigate demographic and disease-related variables associated with syndesmophytes (specifically EAMs).MethodsA cross-sectional study of AxSpA patients was performed, comprising standardised clinical assessment and structured interviews. Validated measures of disease severity were used: BASDAI and ASDAS-CRP (disease activity), BASMI (spinal mobility), HAQ (disability), BASFI (function). Lateral x-rays of the lumbar and cervical spine were performed to quantify syndesmophytes using a validated score (mSASSS) ranging from 0–72, with higher numbers indicating a higher burden. BASRI-hip was used to determine hip involvement, assessed on x-ray of pelvis.ResultsOne hundred and four patients with axSpA were included: 78.8% (n=82) male, 98.1% (n=102) Caucasian, average (SD) age 50.8 (12) years and average disease duration 2513 years. Modified New York (mNY) criteria were fulfilled by 84.6% (n=88) of the cohort. An EAM was present in 29.1% (n=30) of patients. Uveitis was the most prevalent EAM (29%), followed by inflammatory bowel disease (IBD) (18.4%) and psoriasis (17.5%). Average (SD) BASDAI was 3.9 (2.2), ASDAS-CRP 2.3 (1), BASMI 4.2 (1.9), indicating a mild to moderate disease burden in the cohort.Median (IQR) mSASSS was 9.5 (33.8), 10.6% (n=11) of patients had an mSASSS of 0% and 7.7% (n=8) had a bamboo spine. There was no significant difference in the median cervical and lumbar spine mSASSS scores (4 v 6, p>0.05). The distribution of mSASSS was similar in males and females. HLA-B27 status had no effect on mSASSS scores.Increasing mSASSS correlated significantly (p<0.05) with increasing age (rho=0.6), longer disease duration (rho=0.5), rising BASMI (rho=0.8), higher BASFI (rho=0.4) and higher HAQ (rho=0.3). Worsening hip disease, as measured by BASRI, also correlated with an increasing mSASSS (rho=0.4, p<0.01). There was also a statistically significant difference between patients who met mNY criteria compared to those that didn’t (median 14.4 v 2.5, p<0.01).Patients with hypertension had a significantly higher median mSASSS score than patients without (25.4 v 7, p<0.01). Smoking status, hypercholesterolaemia, ischaemic heart disease and diabetes had no impact on mSASSS.The presence or absence of uveitis, psoriasis or IBD had no effect on syndesmophyte formation. Equally, peripheral arthritis had no effect. Patients with moderate or severe hip ...
BackgroundAxial spondyloarthropathy (axSpA) is an inflammatory arthritis which can lead to new bone formation (syndesmophytes) and ankylosis of the spine. Osteoporosis is a recognised feature of axSpA, but can be challenging to diagnose. Traditional dual-energy x-ray absorptiometry (DXA) in the antero-posterior (AP) projection of the spine can overestimate bone mineral density (BMD) due to the presence of syndesmophytes, potentially under-diagnosing osteoporosis. There is a real need to find an accurate method to assess BMD in axSpA patients. Lateral DXA of the lumbar spine is unaffected by syndesmophyte formation and may be a promising tool.ObjectivesThe aim of this study is to:1. investigate different projections of DXA of the lumbar spine in axSpA patients2. assess the effect of syndesmophytes on spine BMD.MethodsAxSpA patients were assessed with clinical exam, questionnaires and laboratory investigations. The burden of syndesmophytes on lateral x-rays of the lumbar and cervical spine was assessed with the validated modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) score, which ranges from 0–72 (higher scores indicate more severe disease). DXA was performed of the spine in both the AP and lateral projections. SPSS was used for statistical analysis.ResultsOne hundred patients with axSpA were recruited: 78% (n=78) male, mean (SD) age 5212 years, disease duration 2613 years, 85% (n=85) fulfil modified New York criteria. The median (IQR) mSASSS score was 10.33 Lumbar spine BMD was lower when measured by lateral DXA rather than AP (0.76 v 1.11 g/cm2, p<0.01). Lateral DXA detected more cases of spinal osteopenia or osteoporosis than AP (21% v 44%, p<0.01). Lateral spine BMD reduced with longer duration of disease (r=-0.3, p=0.02), whereas AP spine BMD increased with age (r=0.3, p=0.01). Women had significantly more cases of osteoporosis at the lumbar spine than men when measured by lateral DXA (32% v 12%, p=0.02), but not by AP DXA.A higher mSASSS, reflecting more syndesmophytes/new bone formation, was associated with a rising AP spine BMD (r=0.5, p<0.01), but had no effect on lateral spine BMD. The gap between AP and lateral spine BMD, i.e. when AP BMD was higher than lateral BMD, increased significantly (p<0.05) with increasing age (r=0.38), disease duration (r=0.37) and mSASSS (r=0.52). mSASSS was the strongest independent predictor of a difference between AP and lateral BMD measurements, suggesting that syndesmophyte formation interferes with AP DXA assessment of the spine.ConclusionsAP DXA of the spine is affected by a higher burden of syndesmophytes (new bone formation), raising concerns that traditional DXA assessment may miss cases of osteoporosis. We suggest that lateral DXA of the spine may be a more accurate tool to detect osteoporosis in axSpA patients.Disclosure of InterestNone declared
BackgroundOsteoporosis is a known consequence of inflammatory arthritis (IA). In the general population and IA such as rheumatoid arthritis, the impact of osteoporosis is well outlined. However, it is often ignored in axial spondyloarthropathy (axSpA), a form of IA centred on sacroiliac joints and the spine, as axSpA predominantly affects men, in whom osteoporosis is often not considered. As a result, osteoporosis prevalence figures are unclear, with wide variation in the literature. Accurate epidemiology regarding bone mineral density (BMD) in axSpA is crucial to begin understanding the impact of low BMD in this cohort.Objectives1. Investigate the prevalence of low BMD in a well-characterised axSpA cohort2. Explore relationships (demographic, disease-related, laboratory) between BMD and axSpA.MethodsA detailed assessment was performed on axSpA patients, including demographics, clinical characteristics and laboratory investigations. Disease severity was assessed with tools validated in axSpA: ASDAS-CRP and BASDAI (disease activity), BASMI (spinal mobility) and BASFI (function). BMD was assessed using DXA of the spine, hip and radius. Lateral vertebral assessment (LVA) was also performed. The WHO criteria were used to classify low BMD. SPSS was used for statistical analysis.ResultsOne hundred and four patients with axSpA were consecutively recruited: 77.9% (n=81) male, 98.1% (n=102) Caucasian, mean (SD) age 5112 years, disease duration 2613 years. The mean (SD) ASDAS-CRP was 2.3 (1), BASDAI was 3.9 (2.2), BASMI was 4.3 (1.9) and BASFI was 3.8 (2.5), reflecting mild to moderate disease burden. A history of fracture was present in 42.3% (n=44) of the cohort, with only 3 fragility fractures reported.Of the cohort, 42.3% (n=44) had osteopenia and 16.3% (n=17) had osteoporosis. Low BMD was most prevalent at the spine, with 44% of the cohort affected, followed by the femoral neck (30.1%, n=22). Low BMD at the radius was uncommon (<10% of the cohort). Only 6.4% of the cohort had a prior diagnosis of osteoporosis and only 39.4% had a previous DXA.Three vertebral fractures were detected on LVA – all patients were unaware of these fractures prior to the study.Female gender, higher BASFI, lower BMI and lower urate levels were significantly associated with bone loss at both the spine and the hip. ASDAS-CRP and BASDAI had no impact on low BMD. Additionally, longer disease duration was associated with spine BMD loss. Non-obese patients were more likely to have low BMD at any site than obese patients (62.3% v 40%, OR 2.5, p=0.04). The use of biologics didn’t influence BMD.ConclusionsLow BMD is common in this axSpA cohort, with over 50% of patients affected. Most cases of low BMD were undiagnosed prior to this study and less than half of the cohort had ever had a DXA, suggesting a continued low awareness of the risk of osteoporosis in a male-dominated disease.Disclosure of InterestNone declared
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