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Sacroiliac radiographic progression over 10 years in axSpA: data from the DESIR inception cohort
  1. Anna Molto1,2,
  2. Clementina López-Medina3,4,
  3. Alexandre Sepriano5,6,
  4. Sofia Ramiro7,8,
  5. Manouk de Hooge9,
  6. Miranda van Lunteren7,
  7. Victoria Navarro-Compán10,
  8. Daniel Wendling11,
  9. Maxime Dougados12
  1. 1Rheumatology, Hospital Cochin Assistance Publique Hôpitaux de Paris, Paris, France
  2. 2INSERM U1153, Center for Research in Epidemiology and Statistics, Université Paris Cité, Paris, France
  3. 3Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
  4. 4GC05, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
  5. 5CHRC Campus Nova Medical School, Lisboa, Portugal
  6. 6Leiden Universitair Medisch Centrum, Leiden, The Netherlands
  7. 7Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  8. 8Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
  9. 9VIB Center of Inflammation Research, Ghent University, Gent, Belgium
  10. 10Rheumatology, La Paz University Hospital, Madrid, Spain
  11. 11Rheumatology, CHU J Minjoz, Besancon, France
  12. 12Hopital Cochin, Rheumatology, Université Paris Descartes Faculté de Médecine, Paris, France
  1. Correspondence to Dr Anna Molto, Rheumatology, Hospital Cochin, Paris, France; anna.molto{at}aphp.fr

Abstract

Objectives To evaluate sacroiliac radiographic progression over a 10-year follow-up and determine the baseline factors associated with such progression in patients with recent-onset axial spondyloarthritis (axSpA, <3 years).

Methods This analysis was performed in the DESIR cohort (NCT01648907). The radiographic status of the patients (radiographic axSpA (r-axSpA) vs non-radiographic axSpA (nr-axSpA)) was based on the modified New York (mNY) criteria. Information on mNY criteria on the pelvic radiographs was obtained in four reading waves over a 10-year period. Images were blinded and centrally read by 3 trained readers. The % of mNY net progressors (ie, number of ‘progressors’ minus number of ‘regressors’ divided by the total number of patients) was assessed in completers (ie, pelvic radiographs at baseline and 10 years). The yearly likelihood of mNY+ was estimated using an integrated analysis (ie, including all patients with at least one available mNY score (‘intention-to-follow’ population) using a generalised estimating equations model and time-varying tumour necrosis factor (TNF) use as a confounder. Baseline predictors of mNY+ during 10 years were evaluated.

Results Completers included 294 patients, while intention-to-follow included 659 participants. In the completers, the net % progression (from nr-axSpA to r-axSpA) was 5.8%. In the intention-to-follow population, the probability of being mNY+ was estimated to increase 0.87% (95% CI 0.56 to 1.19) per year (ie, 8.7% after 10 years) while when introducing TNF inhibitors (TNFi) as a time-varying covariate, the probability was 0.45% (95% CI 0.09 to 0.81) (ie, 4.5% after 10 years). Baseline bone marrow oedema (BME) on MRI of the sacroiliac joints (SIJ) was associated with being mNY+ over time OR 6.2 (95% CI 5.3 to 7.2) and OR 3.1 (95% CI 2.4 to 3.9) in HLA-B27+ and HLA-B27−, respectively). Male sex, symptom duration >1.5 years, Axial Spondyloarthritis Disease Activity Score ≥2.1 and smoking (only in HLA-B27 positives) were also associated with being mNY+ over 10 years. BME was not found to be a mediator of the HLA-B27 effect on mNY+ at 10 years.

Conclusions The yearly likelihood of switching from nr-axSpA to r-axSpA in patients after 10 years of follow-up was low, and even lower when considering TNFi use.

  • spondylitis, ankylosing
  • incidence
  • epidemiology

Data availability statement

Data are available on reasonable request. Data are available on request, and after validation by the DESIR scientific committee.

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Data availability statement

Data are available on reasonable request. Data are available on request, and after validation by the DESIR scientific committee.

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Footnotes

  • Handling editor Josef S Smolen

  • Twitter @annamolto, @AlexSepriano, @sofiaramiro82

  • AM and CL-M contributed equally.

  • AS and SR contributed equally.

  • Contributors AM and CL-M equally contributed to this present work. AS and SR equally contributed to this present work. All authors have contributed to the work, read and finally approved the manuscript for submission. AM accepts full responsability for the work and conduct of the study and acts as guarantor

  • Funding The DESIR cohort is run with the support of unrestricted grants from (in order of decreasing support) Pfizer France, Biogen, AbbVie, UCB, Lilly, Galapagos, Novartis, MSD, Fresenius and Celltrion HealthCare.

  • Competing interests AM has received consulting fees from AbbVie, Amgen, BMS, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB Pharma and Viatris. CL-M has received consulting fees from AbbVie, Janssen, Lilly, Novartis. SR has received research grants and/or consulting fees from AbbVie, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, UCB, Sanofi. AS has received research grants and/or consulting fees from AbbVie, Eli Lilly, Novartis, Medac. MdH has received consultancy/speaker/research grants from UCB. MvL had no competing interests. VN-C has received consultancy/speaker/research grants from AbbVie, BMS, Fresenius Kabi, Galapagos, Janssen, Lilly, Moonlake, MSD, Novartis, Pfizer, Roche, UCB. DW has received consulting fees from AbbVie, BMS, MSD, Pfizer, Nordic Pharma, UCB, Novartis, Lilly, Janssen, Galapagos, Fresenius Kabi. MD has received consulting fees from Pfizer, AbbVie, UCB, Amgen, BMS, Galapagos, Lilly, Novartis, Merck.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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