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A five-year prospective study of spinal radiographic progression and its predictors in men and women with ankylosing spondylitis

Deminger, Anna; Klingberg, Eva; Geijer, Mats LU ; Göthlin, Jan; Hedberg, Martin; Rehnberg, Eva; Carlsten, Hans; Jacobsson, Lennart T. and Forsblad-d'Elia, Helena (2018) In Arthritis Research and Therapy 20(1).
Abstract

Background: Knowledge about predictors of new spinal bone formation in patients with ankylosing spondylitis (AS) is limited. AS-related spinal alterations are more common in men; however, knowledge of whether predictors differ between sexes is lacking. Our objectives were to study spinal radiographic progression in patients with AS and investigate predictors of progression overall and by sex. Methods: Swedish patients with AS, age (mean±SD) 50±13years, were included in a longitudinal study. At baseline and at 5-year follow up, spinal radiographs were graded according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Predictors were assessed by questionnaires, spinal mobility tests and blood samples. Results: Of 204... (More)

Background: Knowledge about predictors of new spinal bone formation in patients with ankylosing spondylitis (AS) is limited. AS-related spinal alterations are more common in men; however, knowledge of whether predictors differ between sexes is lacking. Our objectives were to study spinal radiographic progression in patients with AS and investigate predictors of progression overall and by sex. Methods: Swedish patients with AS, age (mean±SD) 50±13years, were included in a longitudinal study. At baseline and at 5-year follow up, spinal radiographs were graded according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Predictors were assessed by questionnaires, spinal mobility tests and blood samples. Results: Of 204 patients included, 166 (81%) were re-examined and 54% were men. Men had significantly higher mean mSASSS at baseline and higher mean increase in mSASSS than women (1.9±2.8 vs. 1.2±3.3; p=0.005) More men than women developed new syndesmophytes (30% vs. 12%; p=0.007). Multivariate logistic regression analyses with progression ≥2 mSASSS units over 5years or development of new syndesmophytes as the dependent variable showed that presence of baseline AS-related spinal radiographic alterations and obesity (OR 3.78, 95% CI 1.3 to 11.2) were independent predictors of spinal radiographic progression in both sexes. High C-reactive protein (CRP) was a significant predictor in men, with only a trend seen in women. Smoking predicted progression in men whereas high Bath Ankylosing Spondylitis Metrology Index (BASMI) and exposure to bisphosphonates during follow up (OR 4.78, 95% CI 1.1 to 20.1) predicted progression in women. Conclusion: This first report on sex-specific predictors of spinal radiographic progression shows that predictors may partly differ between the sexes. New predictors identified were obesity in both sexes and exposure to bisphosphonates in women. Among previously known predictors, baseline AS-related spinal radiographic alterations predicted radiographic progression in both sexes, high CRP was a predictor in men (with a trend in women) and smoking was a predictor only in men.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ankylosing spondylitis, Inflammation, Longitudinal study, Outcomes research, Radiography, Treatment
in
Arthritis Research and Therapy
volume
20
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85051078686
ISSN
1478-6354
DOI
10.1186/s13075-018-1665-1
language
English
LU publication?
yes
id
8dfde929-7dfa-4b15-b8c9-ae39db020bec
date added to LUP
2018-08-22 11:11:21
date last changed
2019-09-11 04:01:38
@article{8dfde929-7dfa-4b15-b8c9-ae39db020bec,
  abstract     = {<p>Background: Knowledge about predictors of new spinal bone formation in patients with ankylosing spondylitis (AS) is limited. AS-related spinal alterations are more common in men; however, knowledge of whether predictors differ between sexes is lacking. Our objectives were to study spinal radiographic progression in patients with AS and investigate predictors of progression overall and by sex. Methods: Swedish patients with AS, age (mean±SD) 50±13years, were included in a longitudinal study. At baseline and at 5-year follow up, spinal radiographs were graded according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Predictors were assessed by questionnaires, spinal mobility tests and blood samples. Results: Of 204 patients included, 166 (81%) were re-examined and 54% were men. Men had significantly higher mean mSASSS at baseline and higher mean increase in mSASSS than women (1.9±2.8 vs. 1.2±3.3; p=0.005) More men than women developed new syndesmophytes (30% vs. 12%; p=0.007). Multivariate logistic regression analyses with progression ≥2 mSASSS units over 5years or development of new syndesmophytes as the dependent variable showed that presence of baseline AS-related spinal radiographic alterations and obesity (OR 3.78, 95% CI 1.3 to 11.2) were independent predictors of spinal radiographic progression in both sexes. High C-reactive protein (CRP) was a significant predictor in men, with only a trend seen in women. Smoking predicted progression in men whereas high Bath Ankylosing Spondylitis Metrology Index (BASMI) and exposure to bisphosphonates during follow up (OR 4.78, 95% CI 1.1 to 20.1) predicted progression in women. Conclusion: This first report on sex-specific predictors of spinal radiographic progression shows that predictors may partly differ between the sexes. New predictors identified were obesity in both sexes and exposure to bisphosphonates in women. Among previously known predictors, baseline AS-related spinal radiographic alterations predicted radiographic progression in both sexes, high CRP was a predictor in men (with a trend in women) and smoking was a predictor only in men.</p>},
  articleno    = {162},
  author       = {Deminger, Anna and Klingberg, Eva and Geijer, Mats and Göthlin, Jan and Hedberg, Martin and Rehnberg, Eva and Carlsten, Hans and Jacobsson, Lennart T. and Forsblad-d'Elia, Helena},
  issn         = {1478-6354},
  keyword      = {Ankylosing spondylitis,Inflammation,Longitudinal study,Outcomes research,Radiography,Treatment},
  language     = {eng},
  month        = {08},
  number       = {1},
  publisher    = {BioMed Central},
  series       = {Arthritis Research and Therapy},
  title        = {A five-year prospective study of spinal radiographic progression and its predictors in men and women with ankylosing spondylitis},
  url          = {http://dx.doi.org/10.1186/s13075-018-1665-1},
  volume       = {20},
  year         = {2018},
}