Both ASDAS and ADC are associated with spinal mobility in active axial spondyloarthritis: A comparison between early and later disease

Abstract

Objective Using diffusion‐weighted imaging (DWI)‐derived apparent diffusion coefficient (ADC), we aimed to determine the relationship between intensity of spinal inflammation and mobility in patients with axial spondyloarthritis (SpA) in early and later stages of active disease. The Ankylosing Spondylitis Disease Activity Score (ASDAS) was also used for a more comprehensive evaluation. Methods Participants with axial SpA and back pain were recruited from 10 rheumatology centers. Clinical, biochemical and radiological parameters were collected. Short tau inversion recovery (STIR) sequence magnetic resonance imaging (MRI) and DWI of the spine and sacroiliac (SI) joints were performed. ADC maps were generated. Participants were examined for Bath Ankylosing Spondylitis Metrology Index (BASMI). Linear regression models were used to determine associations between BASMI and various clinical, radiological, and MRI parameters in participants with active inflammation on spinal ADC maps. Results One‐hundred and twenty‐seven participants were included in the analyses. Multivariate linear regression showed that mean ADC spine (ß = .16; P = .03), ASDAS‐C‐reactive protein (CRP) (ß = .29, P < .001), and ASDAS‐erythrocyte sedimentation rate (ESR) (ß = .25, P < .01) were associated with BASMI. In participants with duration of back pain ≤3 years, mean spine ADC (ß = .37; P = .03), ASDAS‐CRP (ß = .44; P = .01), and ASDAS‐ESR (ß = .42; P = .01) were associated with BASMI after adjustment for confounding factors. In participants with duration of back pain >3 years, only ASDAS‐CRP (ß = .25; P < .01) and ASDAS‐ESR (ß = .20; P = .20) were associated with BASMI. Conclusion Intensity of inflammation and clinical disease activity were independently associated with impairment of spinal mobility. The associations were stronger in early (≤3 years) than later disease.

Causal Relationships Between Total Physical Activity and Ankylosing Spondylitis: A Mendelian Randomization Study

“…Elsewhere, it has been found that high disease activity of AS is related to low levels of PA in patients ( 34 ). The study has shown that spinal mobility, aerobic capacity, forced vital capacity, and cardiac autonomic regulation were significantly lower in patients with AS and were associated with disease activity ( 35 – 37 ). Enthesitis is related to deteriorated static foot posture in patients with AS ( 38 ).…”

Exploring physical function and physical activity in axial spondyloarthritis: Beyond clinical remission or low disease activity

“…The T2T approach is recommended for managing axSpA and aims to achieve a predefined target, typically a low DA level 12,22 . Evidence suggests that maintaining low DA is linked to a slower progression of structural damage over time 23,24 . Persistently high DA levels are associated with accelerated radiographic spinal progression in the early stage of axSpA 25 .…”

“…12,22 Evidence suggests that maintaining low DA is linked to a slower progression of structural damage over time. 23,24 Persistently high DA levels are associated with accelerated radiographic spinal progression in the early stage of axSpA. 25 Biologic treatment for axSpA patients can improve PF and spinal mobility, which may be impaired by both inflammation and structural damage, with these positive outcomes being long lasting.…”

MRI for axial SpA: Diagnosis, disease activity assessment, and recent advances

“…Another study showed that ASDAS was associated with both the extent and intensity of spinal inflammation in patients with detectable MRI inflammation only. 33 An MRI of the SI joint and/or the spine may be considered based on the physician's discretion to complement clinical and biochemical assessment at the initial stage and to provide an objective assessment of activity for disease monitoring. 34,35…”

“…However, the study showed no correlation between BASDAI and other MRI features including, chronic sacroiliitis, active axial disease, and other MRI changes (costovertebral, costotransverse, and sternoclavicular inflammation). Another study showed that ASDAS was associated with both the extent and intensity of spinal inflammation in patients with detectable MRI inflammation only 33 . An MRI of the SI joint and/or the spine may be considered based on the physician's discretion to complement clinical and biochemical assessment at the initial stage and to provide an objective assessment of activity for disease monitoring 34,35 …”