Are There Any Clues to Predict Bamboo Spine in Axial Spondyloarthritis?

Pamir Atagündüz¹, Sedat Kiraz², Servet Akar³, Orhan Küçükşahin⁴, Abdulsamet Erden⁴, Nihan Coşkun⁵, Burcu Yağız⁵, Cemal Bes⁶, Levent Kılıç⁷, Ömer Karadağ⁷, Timuçin Kaşifoğlu⁸, Hakan Emmungil⁹, Muhammet Çınar¹⁰, Gezmiş Kimyon¹¹, Veli Yazısız¹², Askin Ates¹³, Emine Duygu Ersozlu¹⁴, Emel Gönüllü¹⁵, Rıdvan Mercan¹⁶, İhsan Ertenli² and Umut Kalyoncu², ¹Marmara University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, İstanbul, Turkey, ²Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey, ³Izmir Katip Celebi University, Izmir, Turkey, ⁴Yıldırım Beyazıt University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology,, Ankara, Turkey, ⁵Uludag University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Bursa, Turkey, ⁶Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Bolu, Turkey, ⁷Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara,, Ankara, Turkey, ⁸Eskisehir Osmangazi University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Eskişehir, Turkey, ⁹Trakya University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Edirne, Turkey, ¹⁰University of Health Sciences, Gulhane Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey, ¹¹Hatay Mustafa Kemal University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology,, Hatay, Turkey, ¹²Akdeniz University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology,, Antalya, Turkey, ¹³Ankara University, Ankara, Turkey, ¹⁴Ministry of Health Adana City Hospital, Adana, Turkey, ¹⁵Sakarya University, Department of Internal Medicine, Division of Rheumatology, Sakarya, Turkey, ¹⁶Tekirdag Namik Kemal University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology,, Tekirdağ, Turkey

Meeting: ACR Convergence 2020

Keywords: spondyloarthritis

Session Information

Date: Monday, November 9, 2020

Title: Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster III: Axial SpA

Session Type: Poster Session D

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

Background/Purpose: Complete ankylosis of the entire spinal column is a severe condition seen in spondyloarthritis. This study aims to investigate the possible risk factors associated with the bamboo spine in axial Spondyloarthritis (axSpA) patients treated with biological DMARDs.

Methods: TReasure; is a multicentre database, started in December 2017, in which clinical and demographic data of inflammatory arthritis patients using biological and synthetic DMARDs are recorded (1). This database contains 4911 SpA patients using bDMARD therapy. axSpA patients fulfilling the ASAS classification criteria (Sacroiliitis defined either according to the mNY- or ASAS positive MRI criteria) were analyzed. Patients with complete cervical and lumbar x-rays were divided into three groups. Group-1 consists of patients with a bamboo spine, Group-2 consists of patients with bridging (advanced radiographic involvement) bridging of two vertebrae in a row, Group-3 consists of patients with syndesmophytes in at least one vertebra, and Group-4 consists of patients with no syndesmophytes. The demographic and clinical features of these patients were recorded. One hundred and ten patients were selected as a matched control group based on the disease duration of patients with a bamboo spine.

Results: Out of the 4911 patients in the TReasure database, sacroiliac joint MRI and/or cervical and lumbar lateral radiographs were available for 1381 patients. AS (1071, 77.6%), psoriatic arthritis (102, 7.4%), non-radiographic (144, 10.4%), peripheral SpA (128, 9.3%), enteropathic arthritis (39, 2.8%) in 1381 patient. The bamboo spine was seen in 111 (8.0%), bridging of two vertebrae in a row in 125 (9.0%), syndesmophytes in at least one vertebra in 329 (23.8%), and 816 (59.2%) had no syndesmophytes.

The comparison between the patients with a bamboo spine to those with no syndesmophytes revealed that; male gender (85.6% vs 61.8%, p < 0.001), age (51 (45-61) vs 43 (36-50), p < 0.001), BMI (27.9 (25.9-31.2) vs 25.9 (22.9-29.3) , p < 0.001), smoking as package/year (12.2 (1-30) vs 3 (0-11), p < 0.001), delay in diagnosis of SpA (61 (19-134) vs 12 (5-47), p < 0.001), hip involvement (53.7% vs 17.8%, p < 0.001), family history of SpA (40.8% vs 24.8%, p = 0.014), and uveitis (25.6% vs 13.6%, p = 0.030) were associated with bamboo spine.

Bamboo spine was less common in patients with peripheral arthritis (9.6% vs 21.3%, p = 0.019) and psoriasis (4.5% vs 12.7% , p = 0.031).

Disease activity (BASDAI) and functional status (BASFI) of both patient groups were similar before bDMARD treatment.

In multivariate analysis, male gender OR 9.3 (95% CI 3.2-26.9), hip involvement OR 4.2 (1.8-9.5), family history for SpA OR 2.9 (1.3-6.6), delay in diagnosis 1.013 (1.005-1.021), age 1.11 (1.06 -1.116) as a risk factor.

Conclusion: Male gender, delay in diagnosis, family history of SpA, and hip involvement is the most important risk factors associated with a bamboo spine in axSpA patients, after a disease duration of more than 15 years. Interestingly, the presence of peripheral arthritis and psoriasis were protective.

References:

1) Kalyoncu U, Taşcılar EK, Ertenli Aİ et al. Methodology of a new inflammatory arthritis registry: TReasure. Turk J Med Sci. 2018 Aug 16;48(4):856-861.

Table 1. Demographic and clinical parameters of study patients

Disclosure: P. Atagündüz, None; S. Kiraz, Abbvie, 8, Amgen, 8, Johnson and Johnson, 8, MSD, 8, Novartis, 8, Pfizer, 8, Roche, 8, UCB, 8; S. Akar, None; O. Küçükşahin, Amgen, 8, Johnson and Johnson, 8, MSD, 8, Novartis, 8, Pfizer, 8, Roche, 8, UCB, 8; A. Erden, Amgen, 8, Novartis, 8, Roche, 8, UCB, 8; N. Coşkun, None; B. Yağız, None; C. Bes, None; L. Kılıç, Abbvie, 8, Amgen, 8, MSD, 8, Novartis, 8, Pfizer, 8, Roche, 8, UCB, 8; �. Karadağ, Amgen, 8, Johnson and Johnson, 8, MSD, 8, Novartis, 8, Pfizer, 8, Roche, 8, UCB, 8; T. Kaşifoğlu, Abbvie, 8, Amgen, 8, MSD, 8, Novartis, 8, Pfizer, 8, Roche, 8, UCB, 8; H. Emmungil, Novartis, 8, Roche, 8; M. Çınar, Abbvie, 8, Amgen, 8, MSD, 8, Novartis, 8, Pfizer, 8, Roche, 8, UCB, 8; G. Kimyon, Abbvie, 8, Amgen, 8, Novartis, 8, Pfizer, 8, UCB, 8; V. Yazısız, Abbvie, 8, Actelion, 8, Amgen, 8, MSD, 8, Novartis, 8, Pfizer, 8, Roche, 8, UCB, 8; A. Ates, None; E. Ersozlu, Celltrion, 8, MSD, 8, Novartis, 8, Pfizer Inc, 8, Roche, 8, UCB, 8; E. Gönüllü, None; R. Mercan, Abbvie, 8, Amgen, 8, MSD, 8, Novartis, 8, Pfizer, 8, Roche, 8, UCB, 8; �. Ertenli, Abbvie, 8, Amgen, 8, Johnson and Johnson, 8, MSD, 8, Novartis, 8, Pfizer, 8, Roche, 8, UCB, 8; U. Kalyoncu, Abbvie, 1, Amgen, 1, Jannsenn, 1, Lilly, 1, Novartis, 1, UCB, 1.

To cite this abstract in AMA style:

Atagündüz P, Kiraz S, Akar S, Küçükşahin O, Erden A, Coşkun N, Yağız B, Bes C, Kılıç L, Karadağ �, Kaşifoğlu T, Emmungil H, Çınar M, Kimyon G, Yazısız V, Ates A, Ersozlu E, Gönüllü E, Mercan R, Ertenli �, Kalyoncu U. Are There Any Clues to Predict Bamboo Spine in Axial Spondyloarthritis? [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/are-there-any-clues-to-predict-bamboo-spine-in-axial-spondyloarthritis/. Accessed .

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