Loss and gain of bone in spondyloarthritis: what drives these opposing clinical features?

Clunie, Gavin; Horwood, Nicole J.

doi:10.1177/1759720x20969260

Cited by 25 publications

(18 citation statements)

References 148 publications

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“…In line with previous reports, CRP at the interval start was significantly associated with an increase in the rate of mSASSS progression, supporting the idea that inflammation leads to subsequent osteoproliferation. 27 Although BASDAI at the interval start displayed a pattern of change similar to that of inflammatory markers across age groups, it was not predictive of radiographic progression. As is well known, the presence of syndesmophytes at baseline was a strong predictor of future radiographic progression.…”

Section: Discussionmentioning

confidence: 90%

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

Lee

Koo

Nam

et al. 2022

Therapeutic Advances in Musculoskeletal

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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.

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Section: Discussionmentioning

confidence: 90%

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

Lee

Koo

Nam

et al. 2022

Therapeutic Advances in Musculoskeletal

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“…ADC values may be affected by age, osteoporosis, 36 and skeletal maturity 37 . And active axial SpA is more prone to than inactive disease 38 . Systemic variability of ADC measured from different MRI machines have prompted a proposed use of normalized ADC (nADC) values for analysis 39 .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…Bone resorption as well as new bone formation occur either simultaneously or sequentially in close proximity to the affected skeletal sites in SSpA 24. Bone morphogenic protein and Wnt signalling pathways are involved in pathogenesis of such aberrant bone formation, and possible roles of noggin and sclerostin have recently been suggested in such neo-ossification in SSpA.…”

Section: Discussionmentioning

confidence: 99%

Secondary distal renal tubular acidosis and sclerotic metabolic bone disease in seronegative spondyloarthropathy

et al. 2022

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Adults with distal renal tubular acidosis (dRTA) commonly present with hypokalaemia (with/without paralysis), nephrolithiasis/nephrocalcinosis and vague musculoskeletal symptoms. All adults with dRTA should be thoroughly evaluated for systemic diseases, certain medications and toxins. The leading cause of acquired or secondary dRTA in adults is primary Sjögren syndrome (SS); however, other collagen vascular diseases (CVDs) including seronegative spondyloarthropathy (SSpA) may at times give rise to secondary dRTA. Metabolic bone disease is often encountered in adults with dRTA, and the list includes osteomalacia and secondary osteoporosis; sclerotic metabolic bone disease is an extremely rare manifestation of dRTA. Coexistence of dRTA and sclerotic bone disease is seen in primary dRTA due to mutation in CA2 gene and acquired dRTA secondary to systemic fluorosis. Primary SS and SSpA, rarely if ever, may also lead to both secondary dRTA and osteosclerosis. Circulating autoantibodies against carbonic anhydrase II and possibly calcium sensing receptor may explain both these features in patients with CVD.

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Loss and gain of bone in spondyloarthritis: what drives these opposing clinical features?

Cited by 25 publications

References 148 publications

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

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

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

Secondary distal renal tubular acidosis and sclerotic metabolic bone disease in seronegative spondyloarthropathy

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