Baraliakos X, Listing J, Rudwaleit M, Sieper J, Braun J
Rheumazentrum Ruhrgebiet and Ruhr-University Bochum, Herne, Germany.
Arthritis Rheum. 2009 Jun 15;61(6):764-71. doi: 10.1002/art.24425.
The modified Stokes Ankylosing Spondylitis Spinal Score (mSASSS) quantifies radiographic changes in the cervical spine (C-spine) and the lumbar spine (L-spine), but not in the thoracic spine (T-spine). Our objective was to study the contribution of the lower part of the T-spine to structural damage in patients with ankylosing spondylitis (AS).
Radiographs of 80 AS patients obtained at baseline and after 2 years were scored by 2 readers using the mSASSS. In addition, changes in the lower T-spine (T10-T12) were quantified. On this basis, a new scoring tool was developed: the Radiographic Ankylosing Spondylitis Spinal Score (RASSS). The RASSS includes 2 changes: no scoring of erosions in order to confine the scoring to new bone formation, and no scoring of squaring in the C-spine for anatomic and feasibility reasons.
The mean +/- SD change was 0.9 +/- 2.5 units using the mSASSS and 1.6 +/- 2.8 units using the RASSS (P < 0.001). Although the mSASSS identified new syndesmophytes in mean +/- SD 1.4 +/- 2.9 vertebral edges over 2 years, an additional 0.6 +/- 1.2 vertebral edges were seen in the lower T-spine. New syndesmophytes or ankylosis were found in 15 patients (21.4%; 95% confidence interval [95% CI] 13.1-32.4%) in the C-spine/L-spine and in 6 patients (8.6%; 95% CI 3.8-17.2%) in the T-spine alone. The reliability of the RASSS and the agreement between readers was excellent.
The lower T-spine improves the sensitivity to change of scoring radiographic progression in AS. The tool developed in this study, the RASSS, showed better face and content validity than the mSASSS and was proven to be superior in the quantification of new bone formation in AS.
改良斯托克斯强直性脊柱炎脊柱评分（mSASSS）可对颈椎（C 脊柱）和腰椎（L 脊柱）的影像学改变进行量化，但不能对胸椎（T 脊柱）进行量化。我们的目的是研究 T 脊柱下部对强直性脊柱炎（AS）患者结构损伤的影响。
由两名阅片者使用 mSASSS 对 80 例 AS 患者在基线和 2 年后获得的 X 光片进行评分。此外，对 T 脊柱下部（T10 - T12）的变化进行量化。在此基础上，开发了一种新的评分工具：影像学强直性脊柱炎脊柱评分（RASSS）。RASSS 包括两个变化：为将评分局限于新骨形成而不对侵蚀进行评分；出于解剖学和可行性原因，不对 C 脊柱的椎体方形变进行评分。
使用 mSASSS 时，平均±标准差变化为 0.9±2.5 个单位，使用 RASSS 时为 1.6±2.8 个单位（P < 0.001）。虽然 mSASSS 在 2 年中平均±标准差在 1.4±2.9 个椎体边缘发现了新的骨桥，但在 T 脊柱下部还额外发现了 0.6±1.2 个椎体边缘。在 C 脊柱/L 脊柱中，15 例患者（21.4%；95%置信区间[95%CI]13.1 - 32.4%）发现了新的骨桥或融合，仅在 T 脊柱中，6 例患者（8.6%；95%CI 3.8 - 17.2%）发现了新的骨桥或融合。RASSS 的可靠性以及阅片者之间的一致性非常好。
T 脊柱下部提高了对 AS 影像学进展评分变化的敏感性。本研究开发的工具 RASSS 比 mSASSS 具有更好的表面效度和内容效度，并且在量化 AS 中新骨形成方面被证明更具优势。
