Associations of Changes of Radiographic Disease and Spinal Mobility Measures in Ankylosing Spondylitis

Mark Hwang^1,2,3, Michael Weisman⁴, MinJae Lee⁵, Lianne S. Gensler⁶, Matt Brown⁷, Amirali Tahanan⁵, Laura A. Diekman⁸, Thomas Learch⁹, Seth Eisen¹⁰, Mohammad H. Rahbar⁵, Michael Ward¹¹ and John D. Reveille¹², ¹Medicine, University of Texas-McGovern Medical School, Houston, TX, ²Internal Medicine-Rheumatology, University of Texas-McGovern Medical School, Saint Louis, MO, ³Washington University at Saint Louis School of Medicine, Saint Louis, MO, ⁴Cedars-Sinai Medical Center Division of Rheumatology, Los Angeles, CA, ⁵Biostatistics/Epidemiology/Research Design (BERD) Core | Center for Clinical and Translational Sciences, University of Texas-McGovern Medical School, Houston, TX, ⁶Medicine/Rheumatology, UCSF, San Francisco, CA, ⁷Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Brisbane, Australia, Brisbane, Australia, ⁸Rheumatology, University of Texas-McGovern Medical School, Houston, TX, ⁹Radiology, Cedars Sinai Medical Center, Los Angeles, CA, ¹⁰Division of Rheumatology, Washington University at Saint Louis School of Medicine, St Louis, MO, ¹¹NIH/NIAMS, Bethesda, MD, ¹²University of Texas McGovern Medical School, Houston, TX

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Clinical research, prognostic factors, radiology and spondylarthritis

Session Information

Date: Sunday, November 5, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Metrology indices aimed as assessing spinal mobility in ankylosing spondylitis (AS) patients are used in clinical trials and clinical practice to assess disease severity and progression. The purpose of this study was to examine the association between changes in spinal mobility and radiographic disease in AS patients enrolled in a longitudinal outcome study.

Methods:

AS patients meeting modified New York Criteria with at least 2 sets of radiographs for assessment of modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) spaced at least two years apart were included. Spinal mobility measurements conducted over the same interval as the sets of radiographs included occiput-to-wall distance, cervical rotation, cervical lateral bending, Schober’s and lateral lumbar bending (mean number of sets of mobility measurements per patient, 2.7±0.9). Because some patients had cervical spine films not visualizing the lower segments, the cervical and lumbar spine assessments were analyzed separately. Visits were categorized into 3 groups based on changes of their metrology between visits: improving, worsening or no change in spinal mobility. Longitudinal multivariable negative binomial regression analyses using generalized estimating equation accounting for the correlation of repeated measures over time were conducted to assess associations between each of the respective spinal mobility indices and mSASSS progression. We adjusted each analysis for baseline mSASSS, study sites and clinical/demographic variables (gender, education, disease duration, current smoking status, longitudinal Bath Ankylosing Spondylitis Disease Activity scores, baseline CRP levels, and Patient Global Assessment).

Results:

523 patients met these criteria for the cervical spine analyses and 548 for the lumber spine analyses. The median patient follow up time was 4.08 years (IQR= [2.17, 6.58]) for the cervical spinal and 4.17 years (IQR= [2.17, 6.67]) for the lumbar spinal measurements. Data summarized in Based on multivariable models, increases in occiput to wall distance were significantly associated with increased cervical mSASSS scores compared to no change (adjusted rate ratio (RR) =1.95; p=0.02) and no change in occiput to wall distance was negatively associated with increasing mSASSS compared to decreased occiput to wall distance (adjusted RR= 0.49; p<0.01). Despite a weak trend, no significant differences were noted when comparing positive vs. negative change in lateral cervical bending, cervical rotation, Schober or lateral lumbar bending assessments and changes in the mSASSS.

Conclusion:

Significant associations were observed between longitudinal changes in occiput to wall and mSASSS scores but not between cervical (lateral cervical bending, cervical rotation measures) or lumbar spinal mobility measures (Schober’s, lateral lumbar bending). The occiput-to-wall analysis suggested any change of this measure, positive or negative, was associated with radiographic progression. This suggests that concomitant cervical and lumbar metrology and radiographic disease changes may be measuring different structural phenomena.

Disclosure: M. Hwang, None; M. Weisman, None; M. Lee, None; L. S. Gensler, Janssen Pharmaceutica Product, L.P., 5,Novartis Pharmaceutical Corporation, 5,Amgen, 2,UCB, 2,AbbVie, 2; M. Brown, None; A. Tahanan, None; L. A. Diekman, None; T. Learch, None; S. Eisen, None; M. H. Rahbar, None; M. Ward, None; J. D. Reveille, Janssen, Novartis, 5,UCB, Eli Lilly, 2.

To cite this abstract in AMA style:

Hwang M, Weisman M, Lee M, Gensler LS, Brown M, Tahanan A, Diekman LA, Learch T, Eisen S, Rahbar MH, Ward M, Reveille JD. Associations of Changes of Radiographic Disease and Spinal Mobility Measures in Ankylosing Spondylitis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/associations-of-changes-of-radiographic-disease-and-spinal-mobility-measures-in-ankylosing-spondylitis/. Accessed .

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