Article
Five-year progression of radiographic sacroiliitis in patients with axial spondyloarthritis in ASAS cohort: data of central reading
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Authors
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Mikhail Protopopov
- Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
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Fabian Proft
- Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
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Alexandre Sepriano
- Leiden University Medical Centre, Department of Rheumatology, Leiden, The Netherlands
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Robert Landewé
- Academic Medical Center, Department of Internal Medicine, Division of Rheumatology, Amsterdam, Heerlen, The Netherlands
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Desiree van der Heijde
- Leiden University Medical Center, Department of Rheumatology, Leiden, The Netherlands
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Joachim Sieper
- Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
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Martin Rudwaleit
- Klinikum Bielefeld Rosenhöhe, Bielefeld
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Denis Poddubnyy
- Charité – Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Berlin
| Published: | February 5, 2019 |
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Outline
Text
Background: Radiographic progression of sacroiliitis in axial spondyloarthritis (axSpA) is slow, with only few predictors identified. An analysis of data from Ankylosing Spondylitis Assessment Society (ASAS) Cohort, based on local assessment of radiographs, revealed surprisingly high rate of regression from radiographic axSpA (r-axSpA) to non-radiographic axSpA (nr-axSpA) [1]. We aimed to analyze the rates and predictors for radiographic progression of sacroiliitis in patients with axSpA from the ASAS Cohort, based on the central reading of radiographs.
Methods: Overall 106 patients from the ASAS Cohort diagnosed with axSpA by local rheumatologists, with pelvic radiographs available at baseline and follow-up (mean follow-up time 4.4±0.8 years) were included. Images were independently assessed by 2 central readers (MP, FP), blinded for the chronology of the radiographs, according to the modified New York criteria grading (grade 0-4). In case of discrepancy in classification (nr-axSpA or r-axSpA), the final classification was defined by adjudicator (DP). Sacroiliitis sum score (0-8) was calculated based on scoring results of all readers. The primary outcome was the proportion of patients progressing from nr-axSpA to r-axSpA at follow-up. Predictors of progression were investigated in univariable and multivariable logistic regression analyses.
Results: Among 106 patients, 49 (46.2%) were classified as nr-axSpA, 57 (53.7%) as r-axSpA at baseline. The agreement between primary readers in classification (nr-axSpA or r-axSpA) was moderate to substantial (κ=0.54 – baseline, κ=0.63 – follow-up); between local and central readers – poor to moderate (κ=0.18 – baseline, κ=0.58 – follow-up). At follow-up, 8 (7.5%) patients progressed from nr-axSpA to AS, 6 (5.7%) were reclassified from AS to nr-axSpA. The sacroiliitis sum score increased in 43 (40.6%) patients, decreased in 21 (19.8%) and did not change in 42 (39.6%). Logistic regression analysis showed an association of active and chronic changes on baseline MRI, existing structural damage in sacroiliac joints at baseline and younger age with higher odds for progression from nr-axSpA to r-axSpA.
Conclusion: There was a low but still detectable progression from nr-axSpA to r-axSpA in the ASAS cohort over 4.4 years of follow-up. Active and chronic changes on MRI, initial structural damage on radiographs, and younger age at baseline were associated with higher odds for progression from nr-axSpA to r-axSpA.
