Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that typically affects the axial joint and enthesis. Abnormal hyperplasia of osteoblasts in the vertebral corner is the underlying pathogenesis of syndesmophyte formation. Therefore, detecting abnormal osteoblast hyperactivity in the axial joints of patients with axSpA might be an attractive imaging modality to detect potential of spinal structural progression. Bone scintigraphy is used to evaluate the sites of active bone formation by detecting osteoblast activities and visualizing the whole skeleton at once. Therefore, bone scintigraphy is a theoretically ideal imaging modality to predict abnormal bone growth of axial joints in patients with axSpA.Objectives:To investigate whether bone scintigraphy with semiquantitative analysis in patients with early axial spondyloarthritis (axSpA) has prognostic value for predicting spinal structural progression of these patients after 2 years.Methods:The records of 53 patients with early axSpA who underwent baseline bone scintigraphy were reviewed retrospectively. The sacroiliac joint to sacrum (SIS) ratio of bone scintigraphy was measured for semiquantitative analysis, and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and syndesmophyte growth were calculated at baseline and after 2 years. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff for the SIS ratio of bone scintigraphy. To identify factors associated with significant spinal structural progression, univariate and multivariate logistic regression analyses were performed. Significant progression of spinal structural damage over 2 years was defined as an increase of mSASSS of at least 2 units for 2 years or new syndesmophyte growth/bridging of pre-existing syndesmophytes.Results:Multivariate regression analysis revealed obesity (P = 0.023), current smoking status (P = 0.012), and high SIS ratio of bone scintigraphy (P = 0.015) as independent predictors for worsening mSASSS by at least 2 units over 2 years. For new syndesmophyte growth/bridging of pre-existing syndesmophytes over 2 years, current smoking (P = 0.013), high SIS ratio of bone scintigraphy (P = 0.025), and pre-existing syndesmophyte (P = 0.036) were independent predictors.Conclusion:Semiquantitative analysis of bone scintigraphy (high SIS ratio) in patients with early axSpA may be useful for identifying patients at high risk for spinal structural progression after 2 years.References:[1]Gheita TA, Azkalany GS, Kenawy SA, Kandeel AA. Bone scintigraphy in axial seronegative spondyloarthritis patients: role in detection of subclinical peripheral arthritis and disease activity. Int J Rheum Dis 2015;18:553-9.[2]Kim JY, Choi YY, Kim CW, Sung YK, Yoo DH. Bone Scintigraphy in the Diagnosis of Rheumatoid Arthritis: Is There Additional Value of Bone Scintigraphy with Blood Pool Phase over Conventional Bone Scintigraphy? J Korean Med Sci 2016;31:502-9.Disclosure of Interests:None declared
Background:Mechanical stress are one of the pathogenesis of ankylosing spondlitis (AS). During pregnancy, the mechanical overload on the spine and pelvis increases due to gravid uterus. Recently, computed tomography syndesmophyte score (CTSS) has been developed to analysis of the spinal damage in patients with AS. Indeed, CT has higher sensitivity and reliability compared to conventional radiography in the detection of sacroiliitis.Objectives:We aimed to investigate whether pregnancy and delivery affect radiographic progression of spine and SIJ in women with AS based on CT evaluation.Methods:This retrospective study included women aged 19-49 years with AS who performed at least twice CT scans of whole-spine or sacroilliac joints (SIJ) at intervals of 2 to 4 years. To compare the radiographic progression after delivery, we classified into 2 groups: delivery group or controls. Delivery group was restricted to subjects who had the first CT scans ~2 years before delivery and the second CT scans ~2 years after delivery. CTSS (0-522) and SIJ scores (0-40) were used to evaluate the spinal syndesmophyte and erosion, joint space narrowing, and sclerosis of SIJ.Results:A total of 21 women in delivery group and 38 women in controls were included. The median (Q1-Q3) CTSS at baseline in delivery group and controls were 19 (16-23) and 20 (13.25-27.75), and median progression was 1 (0-3) and 0 (0-1) during the median 2.9 year follow-up. The median (Q1-Q3) SIJ scores at baseline in delivery group and controls were 13 (8-22) and 11 (6-22), and median progression was 1.5 (0-3) and 1 (0-2). The CTSS and SIJ scores significantly increased in both groups, but no difference in absolute score changes per time point between was observed. The changes in SIJ scores was comparable according to the delivery methods.Conclusion:This study suggests that pregnancy and delivery had no effect on radiographic progression of spine and SIJ in female with AS.References:[1]de Bruin F, de Koning A, van den Berg R, Baraliakos X, Braun J, Ramiro S. Development of the CT Syndesmophyte Score (CTSS) in patients with ankylosing spondylitis: data from the SIAS cohort. 2018;77(3):371-7.Disclosure of Interests:None declared.
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