Artikel
Persistently high disease activity according to the ASDAS is associated with accelerated radiographic spinal progression in patients with axial spondyloarthritis
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Autoren
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Denis Poddubnyy
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
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Hildrun Haibel
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
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Jürgen Braun
- Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Herne
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Martin Rudwaleit
- Endokrinologikum Berlin, Berlin
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Joachim Sieper
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektologie, Rheumatologie, Berlin
| Veröffentlicht: | 12. September 2014 |
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Gliederung
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Background: Elevated levels of acute phase reactants have been found to be predictive for radiographic spinal progression in axial spondyloarthritis (axSpA), while no such association has been found so far for clinical disease activity parameters. The aim of the study was to investigate the association between radiographic progression and disease activity as assessed by the composite index “Ankylosing Spondylitis Disease Activity Score” (ASDAS) in axSpA.
Methods: Altogether 177 patients with definite axSpA (100 with ankylosing spondylitis (AS) and 77 with non-radiographic axSpA) from the German Spondyloarthritis Inception Cohort (GESPIC) were included in the current study. Radiographic spinal progression after 2 years of follow up was defined as 1) worsening of the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) by ≥2 units, and 2) development of a new syndesmophyte or progression of existing syndesmophytes (formation of a bridging syndesmophyte). Clinical and lab data were collected at baseline and every 6 months thereafter. Time-averaged values of the ASDAS, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and CRP over two years were calculated.
Results: Rates of radiographic spinal progression were remarkably increased in patients with very high disease activity (time-averaged ASDAS>3.5) – table. There was a significant inter-group difference in rates of syndesmophyte formation between the groups of patients with ASDAS<1.3, 1.3<ASDAS<3.5, and ASDAS>3.5. Patients with very high disease activity had significantly higher odds for syndesmophyte formation as compared to patients with lower disease activity: odds ratio (OR)=5.5 (95%CI 1.89-16.04). In the logistic regression analysis, mSASSS progression by ≥2 points over two years was significantly associated with the time-averaged ASDAS: OR=1.58 (95%CI 1.02-2.44). Even stronger was the relationship between ASDAS and syndesmophyte formation/progression: OR=2.64 (95%CI 1.50-4.64). Importantly, the association of ASDAS with syndesmophyte formation remained significant even after adjustment for time-averaged CRP: OR=2.16 (95%CI 1.13-4.11) (Table 1 [Tab. 1]).
Conclusion: Persisting very high disease activity according to the ASDAS is associated with radiographic spinal progression in axSpA patients with disease duration <10 years. As demonstrated in the multivariate analysis, this effect is at least partially independent of the effect of CRP.
