A five-year prospective study of spinal radiographic progression and its predictors in men and women with ankylosing spondylitis

Abstract

BackgroundKnowledge about predictors of new spinal bone formation in patients with ankylosing spondylitis (AS) is limited. AS-related spinal alterations are more common in men; however, knowledge of whether predictors differ between sexes is lacking. Our objectives were to study spinal radiographic progression in patients with AS and investigate predictors of progression overall and by sex.MethodsSwedish patients with AS, age (mean ± SD) 50 ± 13 years, were included in a longitudinal study. At baseline and at 5-year follow up, spinal radiographs were graded according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Predictors were assessed by questionnaires, spinal mobility tests and blood samples.ResultsOf 204 patients included, 166 (81%) were re-examined and 54% were men. Men had significantly higher mean mSASSS at baseline and higher mean increase in mSASSS than women (1.9 ± 2.8 vs. 1.2 ± 3.3; p = 0.005) More men than women developed new syndesmophytes (30% vs. 12%; p = 0.007). Multivariate logistic regression analyses with progression ≥ 2 mSASSS units over 5 years or development of new syndesmophytes as the dependent variable showed that presence of baseline AS-related spinal radiographic alterations and obesity (OR 3.78, 95% CI 1.3 to 11.2) were independent predictors of spinal radiographic progression in both sexes. High C-reactive protein (CRP) was a significant predictor in men, with only a trend seen in women. Smoking predicted progression in men whereas high Bath Ankylosing Spondylitis Metrology Index (BASMI) and exposure to bisphosphonates during follow up (OR 4.78, 95% CI 1.1 to 20.1) predicted progression in women.ConclusionThis first report on sex-specific predictors of spinal radiographic progression shows that predictors may partly differ between the sexes. New predictors identified were obesity in both sexes and exposure to bisphosphonates in women. Among previously known predictors, baseline AS-related spinal radiographic alterations predicted radiographic progression in both sexes, high CRP was a predictor in men (with a trend in women) and smoking was a predictor only in men.Trial registrationClinicalTrials.gov, NCT00858819. Registered on 9 March 2009. Last updated 28 May 2015.

Association of Uveitis with Radiographic Progression in Patients with Axial Spondyloarthritis: A Propensity Score Matching Analysis

“…In the previous reports, an association of AAU with radiographic progression in axSpA was not significant [13,32]. Essers et al [32] investigated whether the presence of extra-articular manifestations is associated with more radiographic damage.…”

“…In addition, disease duration and age were longer and higher in patients with AAU and a long-term observation over 12 years was also a distinct difference from our study. Deminger et al [13] investigated the predictors of radiographic progression overall and by sex in the 166 patients with axSpA who were followed up over 5 years. Radiographic progression (either as an increase in mSASSS by ≥2 points or as development of new syndesmophyte[s]) in this study was defined over the 5 years, which is quite different from the standard time frame, 2 years, to assess the radiographic progression [22][23][24].…”

“…Several parameters have been identified as risk factors for radiographic progression in patients with axSpA: male sex, smoking, syndesmophyte(s) at baseline, high degree of sacroiliitis on magnetic resonance images, and increased level of C-reactive protein (CRP) [1]. High body mass index (BMI) and peripheral arthritis were also suggested as potential clinical predictors of radiographic progression of the spine [13][14][15][16][17]. However, the relationship between AAU and radiographic progression in axSpA remains unclear.…”

Nonsteroidal Antiinflammatory Drugs as Potential Disease‐Modifying Medications in Axial Spondyloarthritis

“…Using the mSASSS as the measure of disease progression, several risk factors have been associated with AS disease progression in longitudinal studies, including the presence of syndesmophytes at baseline , elevated levels of markers of inflammation , smoking , low bone mineral density , and high disease activity as measured by the AS Disease Activity Score (Table ). In addition, mechanical stress has been associated with worse radiographic outcomes, both in AS cohorts and animal studies .…”

Gender differences in ankylosing spondylitis patients: Relation to clinical characteristics, functional status and disease activity

“…Recently, it has become increasingly evident that the risk factors for spinal radiographic progression are partly different between males and females. Whilst obesity and baseline AS-associated spinal radiographic changes predicted progression in both sexes similarly, yet a high C-reactive protein (CRP) and smoking were among progression risk factors in males, and bisphosphonates usage was a risk factor in females [7].…”