Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system

Creemers, M.C.W.; Franssen, M. J. A. M.; Hof, M.A. van ‘t; Gribnau, F. W. J.; Putte, L.B.A. van de; Riel, P.L.C.M. van

doi:10.1136/ard.2004.020503

Cited by 629 publications

(456 citation statements)

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“…The mean Ϯ SD number of new syndesmophytes per patient was 0.9 Ϯ 1.7 and 0.8 Ϯ 1.1 for the anti-TNF and placebo groups in the clinical trial cohort, respectively, and 0.5 Ϯ 0.9 and 0.6 Ϯ 1.3 for the anti-TNF and standard therapy arms of the observational cohort, respectively. Treatment group comparisons of new syndesmophytes and changes in the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) (27) within each cohort did not show significant differences.…”

Section: Resultsmentioning

confidence: 88%

Focal fat lesions at vertebral corners on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis

Chiowchanwisawakit

Lambert

Conner‐Spady

et al. 2011

Arthritis & Rheumatism

181

117

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Objective. Focal fat infiltration is frequently visible on magnetic resonance imaging (MRI) of the spine in patients with ankylosing spondylitis (AS) and likely reflects postinflammatory tissue metaplasia. To support the concept of coupling between inflammation and new bone formation, we tested the hypothesis that focal fat infiltration at a vertebral corner is more likely to evolve into a de novo syndesmophyte.Methods. MRI scans were obtained at baseline and radiographs were obtained at baseline and 2 years in 100 AS patients from 2 cohorts: a clinical trial cohort (n ‫؍‬ 38) and an observational cohort (n ‫؍‬ 62). In the clinical trial cohort, patients were randomized to receive anti-tumor necrosis factor (anti-TNF) therapy or placebo for 12-24 weeks and then open-label treatment for 2 years. In the observational cohort, patients received either standard therapy (n ‫؍‬ 36) or anti-TNF therapy (n ‫؍‬ 26) for 2 years. Vertebral corner inflammation and fat infiltration were assessed independently by pairs of readers who were blinded with regard to the radiographic findings.Results. New syndesmophytes developed significantly more frequently in vertebral corners with fat in both the clinical trial (10.2%) and the observational (6.5%) cohort as compared to those without either Conclusion. Our data lend support to the hypothesis that inflammatory lesions evolve into new bone through a process of tissue metaplasia that includes fat infiltration.A hallmark of ankylosing spondylitis (AS) is the development of new bone in the spine, which typically leads to ankylosis across the disc spaces. Bone proliferation typically starts at the vertebral rim and grows in the direction of the anulus fibrosus, parallel to the vertebral axis. Ossification may extend across the vertical length of the anulus and becomes visible on radiographs as a syndesmophyte.Until recently, it was hypothesized that ankylosis occurred in response to inflammation and following a reparative process that included cartilage metaplasia. However, data from animal models of spondylarthritis (SpA), principally ankylosing enthesitis, directly challenged this hypothesis by demonstrating that anti-tumor necrosis factor ␣ (anti-TNF␣) therapy did not prevent the development of ankylosis (1). An alternative hypothesis was then proposed whereby pathogenetic factors such as altered gene expression, biomechanical factors, and bacteria trigger the concomitant expression of inflammation and new bone formation, which then proceed

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Section: Resultsmentioning

confidence: 88%

Focal fat lesions at vertebral corners on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis

Chiowchanwisawakit

Lambert

Conner‐Spady

et al. 2011

Arthritis & Rheumatism

181

117

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“…All patients had pelvic x-rays performed confirming the presence of at least grade 2 bilateral, or unilateral grade 3, sacroiliitis. The modified Stoke Ankylosing Spondylitis Severity Score (mSASSS) [7] was determined when cervical and lumbar x-rays were available (n=213); all radiographs were scored independently by two of us (FS, AFM). Where there was discordance between the scores, they were re-evaluated together by both reviewers, and a consensus score was obtained.…”

Section: Data Collectionmentioning

confidence: 99%

“…Metrology is also widely used, providing an objective measure of the effects of the disease on joint mobility; the BASMI [6] is generally the scoring tool for AS metrology. Finally, the mSASSS [7] scores radiographic features of AS and is now considered the preferred method for measurement of damage progression in patients with AS. Reference centile charts have been developed for AS British patients for BASDAI, BASFI and BASMI [8], but no published charts are available from any other population.…”

Section: Introductionmentioning

confidence: 99%

Spectrum of ankylosing spondylitis in Portugal. Development of BASDAI, BASFI, BASMI and mSASSS reference centile charts

et al. 2011

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The availability of population-specific normative data regarding disease severity measures is essential for patient assessment. The goals of the current study were to characterize the pattern of ankylosing spondylitis (AS) in Portuguese patients and to develop reference centile charts for BASDAI, BASFI, BASMI and mSASSS, the most widely used assessment tools in AS. AS cases were recruited from hospital outpatient clinics, with AS defined according to the modified New York criteria. Demographic and clinical data were recorded. All radiographs were evaluated by two independent experienced readers. Centile charts for BASDAI, BASFI, BASMI and mSASSS were constructed for both genders, using generalized linear models and regression models with duration of disease as independent variable. A total of 369 patients (62.3% male, mean±(SD) age 45.4±13.2 years, mean±(SD) disease duration 11.4 ± 10.5 years, 70.7% B27-positive) were included. Family history of AS in a first-degree relative was reported in 17.6% of the cases. Regarding clinical disease pattern, at the time of assessment 42.3% had axial disease, 2.4% peripheral disease, 40.9% mixed disease and 7.1% isolated enthesopatic disease. Anterior uveitis Matthew A Brown and Jaime C Branco equally contributed to this study.

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“…Radiographic sacroiliitis was scored from grade 0 (normal) to grade 4 (ankylosis) according to the modified New York criteria (9). The cervical and lumbar spine was scored according to the modified Stoke AS Spine Score (mSASSS) (27,28).…”

Section: Methodsmentioning

confidence: 99%

The early disease stage in axial spondylarthritis: Results from the german spondyloarthritis inception cohort

Rudwaleit¹,

Haibel²,

Baraliakos³

et al. 2009

Arthritis & Rheumatism

633

406

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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.

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Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system

Cited by 629 publications

References 11 publications

Focal fat lesions at vertebral corners on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis

Focal fat lesions at vertebral corners on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis

Spectrum of ankylosing spondylitis in Portugal. Development of BASDAI, BASFI, BASMI and mSASSS reference centile charts

The early disease stage in axial spondylarthritis: Results from the german spondyloarthritis inception cohort

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