Baraliakos Xenofon, Listing Joachim, von der Recke Anna, Braun Jurgen
Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Herne, Germany.
J Rheumatol. 2009 May;36(5):997-1002. doi: 10.3899/jrheum.080871. Epub 2009 Mar 30.
To describe the natural course of radiographic progression and to differentiate rates of progression in patients with ankylosing spondylitis (AS).
Overall, 146 patients with AS who had never received anti-tumor necrosis factor therapy were analyzed in this retrospective cohort study. The main inclusion criterion was the availability of complete sets of cervical and lumbar radiographs from at least 2 timepoints within 6 years. Using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), we quantified the structural changes and assessed different rates of radiographic progression based on development of new syndesmophytes/year.
The mean followup time was 3.8 +/- 1.7 years (range 1-6) and the mean number of consecutive radiographs was 2.7 (range 2-6) per patient. The mean mSASSS change/year was 1.3 +/- 2.5 units. Radiographic progression showed much variability, since 43% of patients showed a 4-fold greater rate of progression than the mean, and 23% had no progression. The data-based definition for "fast progression" was calculated as a change > 5 mSASSS units or > 2 new syndesmophytes; for "moderate progression" as change of 2.0-5.0 mSASSS units or < 2 new syndesmophytes; and for "slow progression" as change of < 2 mSASSS units or no more than 1 new syndesmophyte within 2 years. The only factor to predict future radiographic progression was the number of syndesmophytes at baseline.
Radiographic progression in AS is rather variable and many patients show high rates of progression. On the basis of this retrospective dataset we propose to differentiate patients on an individual level according to their progression rates: patients with fast, moderate, and slow radiographic progression, assessed by counting new syndesmophytes. Predicting radiographic progression remains difficult; only the prevalence of syndesmophytes at baseline is predictive of future damage.
描述强直性脊柱炎（AS）患者影像学进展的自然病程，并区分其进展速率。
在这项回顾性队列研究中，共分析了146例从未接受过抗肿瘤坏死因子治疗的AS患者。主要纳入标准是在6年内至少有2个时间点的完整颈椎和腰椎X线片。使用改良斯托克强直性脊柱炎脊柱评分（mSASSS），我们量化了结构变化，并根据每年新骨桥形成情况评估了不同的影像学进展速率。
平均随访时间为3.8±1.7年（范围1 - 6年），每位患者连续X线片的平均数量为2.7张（范围2 - 6张）。mSASSS每年的平均变化为1.3±2.5个单位。影像学进展显示出很大的变异性，因为43%的患者进展速率比平均速率快4倍，23%的患者没有进展。“快速进展”的基于数据的定义为变化>5个mSASSS单位或>2个新骨桥；“中度进展”为变化2.0 - 5.0个mSASSS单位或<2个新骨桥；“缓慢进展”为变化<2个mSASSS单位或2年内不超过1个新骨桥。预测未来影像学进展的唯一因素是基线时骨桥的数量。
AS的影像学进展差异较大，许多患者进展速率较高。基于这个回顾性数据集，我们建议根据进展速率在个体水平上区分患者：通过计算新骨桥数量评估为影像学快速、中度和缓慢进展的患者。预测影像学进展仍然困难；只有基线时骨桥的患病率可预测未来的损害。
