Background Identification of patients with axial spondyloarthritis (axSpA) who are at high risk for rapid radiographic progression is of high relevance, because these patients might require an active treatment and they would be the most appropriate candidates for a continuous therapy with non-steroidal anti-inflammatory drugs (NSAIDs).
Objectives To identify factors associated with rapid radiographic spinal progression in patients with early axSpA.
Methods In total, 210 patients with early axial SpA (115 with ankylosing spondylitis (AS) and symptom duration ≤10 years, and 95 with non-radiographic axSpA (nr-axSpA) and symptom duration ≤5 years) from the German Spondyloarthritis Inception Cohort (GESPIC) were selected for this analysis based on the availability of spinal radiographs at baseline and after 2 years of follow-up. Spinal radiographs were scored according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) independently by two trained readers. Rapid radiographic spinal progression was defined as a worsening of the mSASSS score by ≥4 units over 2 years.
Results In total, 15 (7.1%) rapid progressors were identified. The mean±SD worsening of the mSASSS was 7.2±3.9 (range 4.0 to 17.0). Rapid progressors in comparison to those without such a progression had higher level of structural damage in the spine at baseline as assessed by absolute mSASSS values (18.0±15.4 vs. 3.2±6.4, p<0.001) and by the proportion of patients with syndesmophytes (73.3% vs. 19.0%, p<0.001), higher level of functional disability / limitation of spinal mobility as measured by BASFI (4.1±2.2 vs. 2.8±2.3, p=0.030) and BASMI (3.6±1.7 vs. 1.6±1.6, p<0.001), and higher levels of acute phase reactants: C-reactive protein (CRP: 17.9±15.2 vs. 9.1±15.1 mg/l, p=0.001) and erythrocyte sedimentation rate (ESR: 31.5±13.7 vs. 15.9±15.9 mm/h, p<0.001). A higher proportion of heavy smokers (>10 cigarettes a day) among rapid progressors (33.3% vs. 11.8%, p=0.017) was also found. All but one patient (92.3%) in the rapid progression group had low NSAIDs intake over 2 years (ASAS NSAIDs intake score <50) as compared to 72.7% in the remaining patients (p=0.19). There were no statistically significant differences in the prevalence of males, HLA-B27 positivity, and clinical disease activity as measured by BASDAI. Detailed information on the performance of single risk factors and their combinations is presented in table.
Conclusions Prediction of rapid radiographic progression can be reliably done early in the course of axial SpA using assessment of risk factors. Smoking cessation and continuous NSAIDs therapy in these patients might retard radiographic progression.
Disclosure of Interest None Declared
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