Sat0369 spinal Radiographic Progression in Early Spondyloarthritis: Six-Year Results From the Esperanza Cohort

Abstract

Background:There are few studies focused on the development of structural damage over time in patients with early SpAObjectives:The aim of this study is to analyze the mSASSS radiographic progression of spine in patients with early spondyloarthritis (SpA) in the Esperanza cohort.Methods:In this longitudinal study, 49 patients of the Spanish early spondyloarthritis (SpA) Esperanza cohort were included. Every patient had a baseline and a six years lateral X-Ray of the cervical and lumbar of spine. The assessment of spine structural damage was done by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Nine readers, blinded for the diagnosis, participated in the reliability exercise, all of them experienced rheumatologists and members of the Spanish spondyloarthritis working group (GRESSER). The mSASSS progression and development of new syndesmophytes was analyzed. The gold standard of every elemental lesion of the mSASSS and the total mSASSS score was the agreement achieved by the independent categorical opinion of at least five of the nine readers. For reliability, intraclass correlation coefficient (ICC) two-way mixed, absolute agreement was used.Results:Forty-nine patients were included, 69 % were males and 49%, HLA B27 positive. Mean ± SD baseline ESR, CRP, BASDAI, BASFI and mSASSS were 10.7±11.7, 5.4±7.1, 3.7±2.5, 2.1±2.0 and 0.326±0.85, respectively. Inter-reader ICC reliability of the 9 readers was 0.812 (CI 95%; 0.764-0.857). The mSASSS score at the six-year visit was 0.67 ± 1.6: thirty-nine patients did not present any changes in this score at the end of the follow-up, two patients had Δ mSASSS of – 1 and eight patients, an increase in this score (four patients, +1; three patients, +2 and one patient, +9 points).At baseline, five patients presented one syndesmophyte; at the six-year visit, seven had one syndesmophyte; one patient, two syndesmophytes and another one, one bone bridge. Only 2/5 patients (40%) with syndesmophytes at baseline showed an increase in Δ mSASSS; the two patients with a Δ mSASSS of -1 did not have syndesmophytes at baseline. Five out of eight patients (62.5%) with an increase of the Δ mSASSS presented this lesion at the six-year visit but only two of them showed syndesmophytes at baseline. On the other hand, two of the three patients who showed an increase of the ΔmSASSS without syndesmophytes at baseline presented an erosion in the anterior vertebral corner and the patient with the bone bridge had a previous syndesmophyte. Our results indicate that in early SpA much of the progression appears in patients without previous syndesmophytes.Conclusion:Spinal radiographic progression was very low in our early SpA cohort, with a mean progression of 0.3 mSASSS units. Only eight patients (16.3%) presented spinal structural progression, most of them not showing syndesmophytes at baseline. It is reasonable to consider that an early diagnosis and monitoring could result in a low radiographic progression.Disclosure of Interests:Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Jose Francisco Garcia LLorente: None declared, Claudia Urrego-Laurín: None declared, Maria Luz García-Vivar: None declared, Cristina Fernández-Carballido Consultant of: Yes, I have received fees for scientific advice (Abbvie, Celgene, Janssen, Lilly and Novartis), Speakers bureau: Yes, I have received fees as a speaker (Abbvie, Celgene, Janssen, Lilly, MSD, Novartis), María del Carmen Castro Villegas: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp & Dohme, Novartis, Pfizer, Xavier Juanola-Roura: None declared, Carolina Tornero: None declared, E. Galindez: None declared