Age-stratified trends in the progression of spinal radiographic damage in patients with ankylosing spondylitis: a longitudinal study

Abstract

Objective: The objective of this study was to investigate spinal radiographic progression in specific age ranges of ankylosing spondylitis (AS) patients. Methods: Longitudinal data for 1125 AS patients at a single hospital from 2000 to 2018 were retrospectively reviewed. Radiographic intervals were obtained from patients with consecutive spinal radiographs. The radiographic progression rate was defined as the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) change per year within each interval. Using generalized estimating equations (GEEs), estimated marginal means were calculated for the mSASSS progression rate across age groups after adjusting for potential confounders. Results: We obtained 4016 radiographic intervals and stratified them into five groups based on patient age at the interval start: <20 ( n = 122); 20–29 ( n = 1124); 30–39 ( n = 1690); 40–49 ( n = 794); and ⩾50 years ( n = 286). The mean (SD) mSASSS progression rate for all the intervals was 0.8 (1.9). The GEE-estimated mean mSASSS progression rate increased with age, peaking in the 30–39 age group with a value of 1.15 [95% confidence interval (CI) 1.03, 1.27], and decreased slightly thereafter. In the presence of risk factors, rapid progression occurred at earlier ages: the GEE-estimated mean mSASSS progression rate in those with elevated C-reactive protein levels and preexisting syndesmophytes was 2.82 (95% CI 1.93, 3.71) in the 20–29 age group. Conclusion: Spinal structural damage in AS seems to progress most rapidly when patients are age 30–39 years. An awareness of the trends in radiographic progression with advancing age could improve understanding of the natural course of AS.

The impact of smoking status on radiographic progression in patients with ankylosing spondylitis on anti-tumor necrosis factor treatment

“…Second, we calculated radiographic progression rate using baseline mSASSS and the last mSASSS and assumed that the rate of change is constant between them. Caution is needed in interpreting our results since that radiographic progression rate varies across individuals and also can vary within same individuals across time ( 35 , 36 ). Third, Dose-dependent effect of smoking on radiographic progression was not considered.…”

The Relationship between Long-term use of Nonsteroidal Anti-inflammatory Drugs and Kidney Function in Patients with Ankylosing Spondylitis

“…Our data provides evidence for the safety of long-term NSAID use in patients with AS without deterioration of kidney function. However, the results should be interpreted with consideration of the characteristics of AS, which is more prevalent at a young age [15].…”

“…Patients with rheumatic diseases who respond well to NSAIDs, including patients with AS, are often prescribed NSAIDs for a considerable period of time. Although the majority of patients with AS are young [15], there is always concern that long-term use of NSAIDs may leave them vulnerable to impaired kidney function. The purpose of this study was to determine the effect of long-term NSAID treatment on kidney function from electronic medical records (EMR) collected over 18 years in patients with AS.…”

Association Between Changes in Serum Alkaline Phosphatase Levels and Radiographic Progression in Ankylosing Spondylitis

“…Real-world data based on EMRs seem to be suitable for analysing data related to long-term radiographic progression in patients with AS 10,[16][17][18]29 . However, the variables collected in retrospective studies are inevitably limited.…”