Leiden University Medical Center, Leiden, and Zuyderland Medical Center, Heerlen, The Netherlands.
Leiden University Medical Center, Leiden, The Netherlands.
Arthritis Care Res (Hoboken). 2019 Dec;71(12):1678-1684. doi: 10.1002/acr.23796. Epub 2019 Nov 14.
To analyze the progression of spinal radiographic damage in patients with early axial spondyloarthritis (SpA).
Axial SpA patients from the DESIR (Devenir des Spondylarthropathies Indifférenciées Récentes) cohort with 5-year spinal (cervical and lumbar) radiographs available (n = 549) were included. Two- and 5-year modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) progression and development of new syndesmophytes (net change: the number of patients with positive change minus the number of patients with negative change divided by the total number of patients) were assessed in subgroups defined at baseline according to the Assessment of SpondyloArthritis international Society axial SpA criteria and its arms, modified New York criteria (mNYC) and the presence of syndesmophytes.
Mean ± SD mSASSS progression was 0.2 ± 0.9 at 2 years and 0.4 ± 1.8 at 5 years. Five-year progression was higher in the imaging arm (mean ± SD 0.6 ± 2.3), magnetic resonance imaging (MRI)+/mNYC+ (mean ± SD 1.3 ± 4.0), than in the clinical arm only (mean ± SD 0.1 ± 0.7), and highest in patients with syndesmophytes (mean ± SD 2.7 ± 5.0). At 5 years, 7% of all patients had a net change of any new syndesmophyte; this value was 10% for the imaging arm (mNYC+/MRI+ with 18%), 17% for mNYC+ patients, and 42% for patients with syndesmophytes.
Spinal radiographic progression, although limited in early axial SpA, can be captured after 2 years. Inflammation and damage in the sacroiliac joint are associated with higher radiographic progression. The presence of baseline syndesmophytes already strongly predicts the development of further structural damage early in the disease.
分析早期中轴型脊柱关节炎（SpA）患者脊柱放射学损伤的进展情况。
纳入来自 DESIR（新近未分化脊柱关节病的转归）队列的、具有 5 年脊柱（颈椎和腰椎）影像学资料的中轴型 SpA 患者（n=549）。根据评估脊柱关节炎国际协会中轴型 SpA 标准及其分支、改良纽约标准（mNYC）和骨桥形成情况，在基线时将患者分为不同亚组，评估这些亚组患者的 2 年和 5 年改良 Stoke 强直性脊柱炎脊柱评分（mSASSS）进展情况和新骨桥形成情况（净变化：阳性变化的患者数减去阴性变化的患者数除以总患者数）。
2 年时 mSASSS 进展的平均值±标准差为 0.2±0.9，5 年时为 0.4±1.8。影像学组（平均值±标准差 0.6±2.3）、MRI+/mNYC+（平均值±标准差 1.3±4.0）的 5 年进展高于仅临床组（平均值±标准差 0.1±0.7），而骨桥形成患者的进展最高（平均值±标准差 2.7±5.0）。在 5 年时，所有患者中有 7%的患者出现任何新骨桥的净变化；影像学组（mNYC+/MRI+ 为 18%）为 10%，mNYC+患者为 17%，骨桥形成患者为 42%。
尽管在早期中轴型 SpA 中脊柱放射学进展有限，但在 2 年后可以发现这种进展。骶髂关节的炎症和损伤与更高的放射学进展相关。基线时存在骨桥形成已经强烈预示着疾病早期进一步发生结构损伤。
