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Both structural damage and inflammation of the spine contribute to impairment of spinal mobility in patients with ankylosing spondylitis
  1. Pedro Machado1,2,
  2. Robert Landewé3,
  3. Jürgen Braun4,
  4. Kay-Geert A Hermann5,
  5. Daniel Baker6,
  6. Désirée van der Heijde2
  1. 1Rheumatology, Coimbra University Hospital, Coimbra, Portugal
  2. 2Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Rheumatology, University Hospital Maastricht, Maastricht, The Netherlands
  4. 4Rheumatology, Rheumazentrum Ruhrgebiet, Herne, Germany
  5. 5Radiology, Charité Medical School, Berlin, Germany
  6. 6Research and Development, Centocor Inc, Malvern, Pennsylvania, USA
  1. Correspondence to Professor Désirée van der Heijde, Department of Rheumatology, Leiden University Medical Center, PO Box 9600, Leiden, RC 2300, The Netherlands; d.vanderheijde{at}


Objective To study the relationship between spinal mobility, radiographic damage of the spine and spinal inflammation as assessed by MRI in patients with ankylosing spondylitis (AS).

Methods In this subanalysis of the Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy cohort, 214 patients, representing an 80% random sample, were investigated. Only baseline data were used. MRI inflammation was assessed by the AS spinal MRI activity (ASspiMRI-a) score, structural damage by the modified Stoke AS Spine Score (mSASSS) and spinal mobility by the linear definition of the Bath Ankylosing Spondylitis Metrology Index (BASMI). Univariate correlations were calculated on baseline values using Spearman rank correlation. Independent associations between the variables of interest were investigated by multivariate linear regression analysis. Associations with clinical disease activity, C-reactive protein, disease duration, age, gender, body mass index and HLA-B27 status were also investigated. Subanalyses were performed according to disease duration.

Results BASMI correlated moderately well with mSASSS (Spearman's ρ=0.6) and weakly with ASspiMRI-a (ρ=0.3). A best-fit model for BASMI included both mSASSS (regression coefficient (B)=0.865, p<0.001) and ASspiMRI-a (B=0.236, p=0.018). In patients with a disease duration ≤3 years, B was greater for ASspiMRI-a than for mSASSS (0.595 vs 0.380), while in patients with a disease duration >3 years B was greater for mSASSS than for ASspiMRI-a (0.924 vs 0.156).

Conclusion Spinal mobility impairment in AS is independently determined both by irreversible spinal damage and by reversible spinal inflammation. Spinal mobility impairment is more influenced by spinal inflammation in early disease, and by structural damage in later disease.

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  • Funding PM was supported by the Fundação para a Ciência e Tecnologia grant SFRH/BD/62329/2009 (Fundação para a Ciência e a Tecnologia, Loja do Cientista, Av D Carlos I, 124 J, 1249-074 Lisbon, Portugal). The ASSERT trial (Arthritis Rheum 2005;52:582–91) was supported by Centocor, Inc, Malvern, Pennsylvania, USA.

  • Competing interests None.

  • Ethics approval Ethics committee approval was secured for the ASSERT trial (Arthritis Rheum 2005;52:582–91). This study is an investigator-preformed subanalysis of the ASSERT cohort.

  • Provenance and peer review Not commissioned; externally peer reviewed.