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MRI inflammation at the vertebral unit only marginally predicts new syndesmophyte formation: a multilevel analysis in patients with ankylosing spondylitis
  1. Désirée van der Heijde1,
  2. Pedro Machado1,2,
  3. Jürgen Braun3,
  4. Kay-Geert A Hermann4,
  5. Xenofon Baraliakos3,
  6. Benjamin Hsu5,
  7. Daniel Baker5,
  8. Robert Landewé6
  1. 1Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Rheumatology Department, Coimbra University Hospital, Coimbra, Portugal
  3. 3Rheumatology, Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany
  4. 4Radiology Department, Charité Medical School, Berlin, Germany
  5. 5Research and Development, Centocor Inc., Malvern, Pennsylvania, USA
  6. 6Rheumatology Department, Academic Medical Center, Amsterdam and Atrium Medical Center, Heerlen, The Netherlands
  1. Correspondence to Professor Désirée van der Heijde, Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands; d.vanderheijde{at}


Objective To investigate the relationship between MRI inflammation at the vertebral unit and the formation and growth of syndesmophytes at the same vertebral unit.

Methods An 80% random sample of the ASSERT database was analysed. MRI were scored using the ankylosing spondylitis (AS) spinal MRI activity score (at baseline, 24 and 102 weeks) and spinal x-rays were scored using the modified Stoke AS spine score (at baseline and 102 weeks). Data were analysed at the patient level and the vertebral unit level using a multilevel approach to adjust for within-patient correlation.

Results There was a slightly increased probability of developing syndesmophytes in vertebral units with MRI activity, which was maintained after adjustment for within-patient correlation (per vertebral unit level) and treatment, and after further adjustment for potential confounders, resulting in significant OR ranging from 1.51 to 2.26. Growth of existing syndesmophytes at the vertebral unit level was not associated with MRI activity. At the patient level only a trend for an association was observed.

Conclusion MRI inflammation in a vertebral unit slightly increases the propensity to form a new syndesmophyte in the same vertebral unit, but does not predict the growth of already existing syndesmophytes. Despite this association, the large majority of new syndesmophytes developed in vertebral units without inflammation. The subtle association at the vertebral unit level did not translate into an association at the patient level.

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  • Funding PM was supported by the Fundação para a Ciência e a Tecnologia (FCT) grant SFRH/BD/62329/2009.

  • Competing interest None.

  • Ethics approval Ethics committee approval was secured for the ASSERT trial. This study is an investigator-preformed subanalysis of the ASSERT cohort.

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

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