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Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system
  1. M C W Creemers1,
  2. M J A M Franssen2,
  3. M A van ’t Hof3,
  4. F W J Gribnau4,
  5. L B A van de Putte1,
  6. P L C M van Riel1
  1. 1Department of Rheumatology, University Medical Centre St Radboud, Nijmegen, The Netherlands
  2. 2Department of Rheumatology, St Maartenshospital, Nijmegen, The Netherlands
  3. 3Department of Medical Statistics, Catholic University, Nijmegen, The Netherlands
  4. 4Department of Clinical Pharmacology, University Medical Centre St Radboud, Nijmegen, The Netherlands
  1. Correspondence to:
    Dr M C W Creemers
    Department of Rheumatology, University Medical Centre St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands; m.creemersreuma.umcn.nl

Abstract

Objective: To develop and validate an extensive radiographic scoring system for ankylosing spondylitis (AS).

Methods: The Stoke Ankylosing Spondylitis Spinal Score (SASSS) was modified by adding a score for the cervical spine and defining squaring. This modified SASSS (mSASSS) is the sum of the lumbar and cervical spine score (range 0–72). 370 lateral views of the lumbar and cervical spine were used for development of the mSASSS, standardisation of observers, and for studying reliability. In a 48 week NSAID study of 57 patients, change over time and construct validity were studied.

Results: Interobserver correlations of the lumbar and cervical spine scores were good (r>0.95). The interobserver duplicate error was 0.55 in a range from 0 to 36. The mean change in the cervical and lumbar spine scores between weeks 0 and 48 of all patients was 1.45 (range 0–6.0) and 1.06 (0–5.0), respectively (paired t testing, p<0.001). Change in radiological score was seen in 36/57 (63%) patients (lumbar and cervical spine 11, cervical spine 12, lumbar spine 13 patients).

Conclusion: The mSASSS is useful for assessing extensive radiographic damage in AS. It is reliable, detects changes over 48 weeks, and shows a satisfactory face and construct validity.

  • AS, ankylosing spondylitis
  • mSASSS, modified Stoke Ankylosing Spondylitis Spinal Score
  • NSAID, non-steroidal anti-inflammatory drug
  • VAS, visual analogue scale
  • ankylosing spondylitis
  • outcome assessment
  • radiographic scoring method
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Footnotes

  • Acting editor: Frank A Wollheim

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