Objective The aim of this work was to investigate the association between disease activity measured by the Ankylosing Spondylitis Disease Activity Score (ASDAS) and radiographic spinal progression in patients with early axial spondyloarthritis (axSpA).
Methods Altogether, 178 patients with definite axSpA (100 with ankylosing spondylitis and 78 with non-radiographic axSpA) were included. Spinal radiographs (baseline and year 2) were assessed according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and for the presence of syndesmophytes. Clinical and lab data were collected at baseline and every 6 months thereafter. Time-averaged (over 2 years) values of the C-reactive protein based ASDAS were calculated.
Results There was a clear positive association between disease activity according to ASDAS and radiographic spinal progression. In the logistic regression analysis, mSASSS progression by ≥2 points over 2 years was significantly associated with the time-averaged ASDAS: unadjusted OR=1.64 (95% CI 1.03 to 2.62), adjusted (for presence of syndesmophytes at baseline, smoking status and intake of non-steroidal anti-inflammatory drugs) OR=1.80 (95% CI 1.04 to 3.13). Syndesmophyte formation/progression demonstrated an even stronger association with the time-averaged ASDAS: unadjusted OR=2.62 (95% CI 1.46 to 4.68), adjusted OR=2.45 (95% CI 1.26 to 4.77).
Conclusions Persisting high disease activity according to the ASDAS is associated with accelerated radiographic spinal progression in early axSpA.
- Ankylosing Spondylitis
- Disease Activity
- Outcomes research
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Handling editor Tore K Kvien
Contributors All authors were involved in data analysis and/or interpretation, drafting the article or revising it critically for important intellectual content. DP had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding GESPIC has been financially supported by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung—BMBF). As funding by BMBF was reduced according to schedule in 2005 and stopped in 2007, complementary financial support has been obtained also from Abbott/Abbvie, Amgen, Centocor, Schering-Plough and Wyeth. Since 2010, GESPIC has been supported by Abbvie; additional support has been obtained from ANCYLOSS (grant number FKZ 01EC1002D), ArthroMark (grants numbers FKZ 01EC1009A and FKZ 01EC1401A) and METARTHROS (grant number FKZ 01EC1407A) projects funded by BMBF.
Competing interests None declared.
Ethics approval Ethics committee of the Charité Universitätsmedizin Berlin.
Provenance and peer review Not commissioned; externally peer reviewed.
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