早期AS和早期中轴型SpA随访2年的脊柱放射学进展

 

原文

译文

THU0449

RATES AND PREDICTORS OF RADIOGRAPHIC SPINAL PROGRESSION OVER TWO YEARS IN PATIENTS WITH EARLY AXIAL SPONDYLOARTHRITIS

D. Poddubnyy ^1,*, H. Haibel ¹, J. Listing ², E. Märker-Hermann ³, H. Zeidler ⁴, J. Braun ⁵, J. Sieper ¹, M. Rudwaleit ⁶

¹Charité Universitätsmedizin, ²DRFZ, Berlin, ³Dr. Horst Schmidt Kliniken, Wiesbaden, ⁴Medizinische Hochschule, Hannover, ⁵Rheumazentrum Ruhrgebiet, Herne, ⁶Ev. Krankenhaus Hagen-Haspe, Hagen, Germany

 

Background: There are some data available on the frequency of structural damage in the spine in patients with ankylosing spondylitis (AS) and about potential risk factors for the development of syndesmophytes, but these data refer exclusively to patients with longstanding AS. Nearly no data exist regarding rates and predictors of radiographic spinal progression in early axial spondyloarthritis (SpA).

Objectives: To investigate rates and predictors of structural damage development in the spine in patients with early axial SpA (AS with symptoms duration of <10 years and nrSpA with symptoms duration of <5 years).

Methods: 210 patients with axial SpA (115 with AS according to the modified New York criteria and 95 with nrSpA) from the German Spondyloarthritis Inception Cohort (GESPIC) were selected for this analysis based on availability of radiographs (sacroiliac joints, lumbar and cervical spine lateral views) at baseline and after 2 years of follow-up. Images were centrally collected, digitized, and subsequently scored independently by two trained readers. Spinal radiographs were scored according to the mSASSS scoring system. The readers scored both time points simultaneously but were blinded for the time point and for all clinical data.

Results: There was a radiographic progression of 0.95±2.78 mSASSS points over two years in the AS group and a lower progression of 0.47±1.63 mSASSS point in the nrSpA subgroup (p=0.23 for the difference). Significant radiographic progression was defined as a worsening of the mean mSASSS score by ≥2 points over two years. Altogether, 14.3% of the patients in the whole SpA group showed spinal radiographic progression according to this definition.  This rate was higher in the group of patients with AS (20%) in comparison to non-radiographic axial SpA (7.4%). Several predictors of radiographic spinal progression were identified in the univariate analysis (table). However, a multivariate analysis confirmed predictor status only for the presence of syndesmophytes (OR=4.78, p<0.001), elevated CRP (OR=2.50, p=0.047) and smoking status (OR=2.41, p=0.047). No clear association with radiographic spinal progression was found for age, HLA-B27 status, BASDAI, BASFI, presence of peripheral arthritis, enthesitis, psoriasis, SpA family history.

Conclusions: Radiographic spinal progression over two years was observed in 20% of the AS patients and in 7% of the nrSpA patient in this early SpA cohort. The presence of radiographic damage in the spine (syndesmophytes) and, to a letter extend, elevated CRP and cigarette smoking predict spinal radiographic progression in early axial SpA.

 Table. Association of clinical, radiographic and laboratory parameters with spinal radiographic progression (≥2 mSASSS points over two years) in patients with axial SpA

Parameters at baseline	OR (95% CI)	p-value
AS vs. nrSpA	3. 4 (1.28-7.69)	0.012
Syndesmophytes, present vs. not present	6.29 (2.77-14.26)	<0.001
Sex, male vs. female	2.14 (0.95-4.82)	0.067
CRP, >6 mg/l vs. ≤6 mg/l	2.47 (1.12-5.44)	0.025
Mean CRP over 2 years*, >6 mg/l vs. ≤6 mg/l	3.81 (1.68-8.63)	0.001
Smokin , present vs. not present	2.75 (1.25-6.05)	0.012

*C-reactive protein (CRP) levels were detected at baseline and every 6 months thereafter

 

早期AS和早期中轴型SpA随访2年的脊柱放射学进展

D. Poddubnyy，EULAR 2011. Present No: THU0449

 

背景：虽然对强直性脊柱炎患者的脊柱结构损害比率以及发展为韧带骨赘潜在的风险因素有一些研究数据可用，但这些数据仅限于长期的强直性脊柱炎患者。近期还没有针对早期中轴型脊柱关节病患者的脊柱放射学进展比例及预测因子的数据。

 

目的：调查早期中轴型脊柱关节病患者脊柱结构损害的比例及预测因子。（病程<10年的有症状强直性脊柱炎患者和病程<5年的无放射学改变的有症状脊柱关节病患者）

 

方法：从GESPIC研究中选取210名中轴脊柱关节病患者（115名强直性脊柱炎，符合修订的纽约标准，95名无放射学改变的脊柱关节病患者），患者自GESPIC研究中选取，这些患者均在基线和2年的随访中进行放射学照片（骶髂关节，腰椎和颈椎侧位片）检查。放射照片由中心收集，数字化，随后由2名受过专业训练的读片人进行独立评分。脊柱放射片按mSASSS评分系统评分。读片人对不同时间点的放射片同时评分，但时间点及所有的临床数据对读片人为盲态。

 

结果：强直性脊柱炎组2年后mSASSS评分放射学进展为0.95±2.78，无放射学改变脊柱关节病患者组较低，为0.47±1.63（p=0.23）。mSASSS评分均值≥2分定义为显著放射学进展。全部患者的14.3%有显著放射学进展。强直性脊柱炎组（20%）高于无放射学改变脊柱关节病患者组（7.4%）。单变量分析发现了几个脊柱放射学进展的预测因子（表）。然而，多变量分析中，仅证实韧带骨赘（OR=4.78, p<0.001)，CRP升高(OR=2.50, p=0.047)以及吸烟(OR=2.41, p=0.047)。没有明确脊柱放射学进展与年龄、HLA-B27、BASDAI, BASFI, 外周关节炎, 附着点炎, 银屑病, 家族史有关。.

 

结论：在早期脊柱关节病患者，20%的强直性脊柱炎患者和7%的无放射学改变脊柱关节病患者随访2年可以观察到脊柱放射学进展。对早期中轴型脊柱关节病患者，脊柱放射学损害的存在（韧带骨赘），CRP升高和吸烟可以预测脊柱放射学进展

表 中轴脊柱关节病患者临床、放射学和实验室检查与脊柱放射学进展（2年后mSASSS评分≥2）相关性

基线参数	OR (95% 可信区间)	P值
强直性脊柱炎 vs. 无放射学改变脊柱关节病	3.14 (1.28-7.69)	0.012
韧带骨赘, 有 vs 无	6.29 (2.77-14.26)	<0.001
性别， 男 vs 女	2.14 (0.95-4.82)	0.067
CRP, >6 mg/l vs. ≤6 mg/l	2.47 (1.12-5.44)	0.025
CRP均值 2年后*, >6 mg/l vs. ≤6 mg/l	3.81 (1.68-8.63)	0.001
吸烟,有 vs. 无	2.75 (1.25-6.05)	0.012

*C-反应蛋白 (CRP)水平在基线和每隔6月检测