Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: In AS, spinal radiographic progression shows a very heterogeneous course. Our aim was to investigate which patient characteristics are of influence on the course of spinal radiographic progression in AS patients treated long-term with TNF-α inhibitors.
Methods: Consecutive patients from the Groningen Leeuwarden AS (GLAS) cohort who started TNF-α inhibitors, with baseline and biannual spinal radiographs until 6 years of follow-up were included. Radiographs were scored using mSASSS by two independent readers. Generalized estimating equations (GEE) were used to explore the associations between baseline characteristics and radiographic damage over time. The course of radiographic progression was investigated with different time functions (linear and non-linear), stratified for significantly associated patient characteristics. In case of missing radiographic data at one or more intermediate follow-up visits, single linear imputation was used.
Results: 80 AS patients reached 6 years of follow-up (mean mSASSS 8.2±12.9) of which 53 patients had complete radiographic data at all 2-year time points. Baseline syndesmophytes, male gender, older age, longer disease duration, and higher BMI were significantly associated with more radiographic damage over time. Baseline syndesmophytes was the only independent risk factor. GEE analysis in patients with these characteristics revealed that mSASSS progression followed a non-linear course; mean mSASSS progression rate reduced from maximal 2.8 units over 0-2 years to minimal 0.9 units over 4-6 years (Table 1). A linear course with overall lower progression scores over the 2-year intervals (≤1 mSASSS units/2yrs) was found in patients without risk factors (Table 1). Complete case analysis in 53 patients revealed similar results.
Conclusion: AS patients who are at risk of poor radiographic outcome showed the largest but diminishing spinal radiographic progression over time during long-term treatment with TNF-α inhibitors. Only little and linear progression was observed in patients without risk factors such as no syndesmophytes, shorter symptom duration, and normal BMI. Table 1. Radiographic damage at baseline and estimated mean spinal radiographic progression scores over time of AS patients stratified for baseline risk factors.
Best time model
mSASSS progression scores
|Symptom duration||≥10 years||52||12.3±15.2||Non-linear||2.3||2.0||1.3|
|Time since diagnosis||≥5 years||44||11.4±15.2||Non-linear||2.2||1.9||1.3|
To cite this abstract in AMA style:Maas F, Arends S, Wink F, Bos R, Bootsma H, Brouwer E, Spoorenberg A. Diminished Spinal Radiographic Progression during Long-Term Treatment with TNF-α Inhibitors in Ankylosing Spondylitis Patients at Risk of Poor Radiographic Outcome [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/diminished-spinal-radiographic-progression-during-long-term-treatment-with-tnf-%ce%b1-inhibitors-in-ankylosing-spondylitis-patients-at-risk-of-poor-radiographic-outcome/. Accessed July 8, 2020.
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