Ismail Sari1,2, Seunghun Lee1,3, George Tomlinson4,5,6, Sindhu R Johnson1,6, Robert D Inman1,7, Nigil Haroon1,7. 1. Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. 2. Dokuz Eylul University School of Medicine, Department of Rheumatology, Izmir, Turkey. 3. Department of Radiology, Hanyang University Hospital, College of Medicine, Seoul, Korea. 4. Department of Medicine, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada. 5. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 6. Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada. 7. Krembil Research Institute, University Health Network, University of Toronto, Ontario, Canada.
Abstract
OBJECTIVES: Using a longitudinal observational cohort of ankylosing spondylitis (AS) patients, we sought to identify progression rates, and factors predictive of spinal progression. As a secondary aim we analyzed the effect of tumor necrosis factor inhibitor (TNFi) treatment on radiographic progression. METHODS: AS patients who had baseline and follow-up cervical and lumbar X-rays were included in the study. Radiographic damage was assessed by the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). A change of 2 mSASSS units in 2 years was defined as progression. The characteristics of the study group such as demographic, clinical, laboratory, and treatment history were collected. RESULTS: There were 350 patients in the study. The mean mSASSS increased from 9.3 (15.8) units at baseline to 17.7 (21.7) units by the 6th year. Change in mSASSS scores between the 0 to 2, 2 to 4 and 4 to 6 years were 1.23 (2.68), 1.47 (2.86), and 1.52 (3.7) units respectively. Overall 24.3% of the group progressed in 2 years' time. Male sex (HR 2.46, 95%CI 1.05, 5.76), presence of baseline damage (HR 7.98, 95%CI 3.98, 16), increased inflammatory markers (logCRP; HR 1.35, 95%CI 1.07, 1.70) and TNFi use (HR 0.82, 95%CI 0.70, 0.96) were predictive of radiographic progression. There was a 20% reduction in the rate of progression with TNFi. CONCLUSION: Male sex, presence of baseline damage, active disease state and higher inflammatory markers confer a high-risk group for disease progression. Treatment with TNFi showed a disease modifying effect by slowing the rate of radiographic progression.
OBJECTIVES: Using a longitudinal observational cohort of ankylosing spondylitis (AS) patients, we sought to identify progression rates, and factors predictive of spinal progression. As a secondary aim we analyzed the effect of tumor necrosis factor inhibitor (TNFi) treatment on radiographic progression. METHODS: AS patients who had baseline and follow-up cervical and lumbar X-rays were included in the study. Radiographic damage was assessed by the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). A change of 2 mSASSS units in 2 years was defined as progression. The characteristics of the study group such as demographic, clinical, laboratory, and treatment history were collected. RESULTS: There were 350 patients in the study. The mean mSASSS increased from 9.3 (15.8) units at baseline to 17.7 (21.7) units by the 6th year. Change in mSASSS scores between the 0 to 2, 2 to 4 and 4 to 6 years were 1.23 (2.68), 1.47 (2.86), and 1.52 (3.7) units respectively. Overall 24.3% of the group progressed in 2 years' time. Male sex (HR 2.46, 95%CI 1.05, 5.76), presence of baseline damage (HR 7.98, 95%CI 3.98, 16), increased inflammatory markers (logCRP; HR 1.35, 95%CI 1.07, 1.70) and TNFi use (HR 0.82, 95%CI 0.70, 0.96) were predictive of radiographic progression. There was a 20% reduction in the rate of progression with TNFi. CONCLUSION: Male sex, presence of baseline damage, active disease state and higher inflammatory markers confer a high-risk group for disease progression. Treatment with TNFi showed a disease modifying effect by slowing the rate of radiographic progression.