Session Information
Date: Sunday, November 17, 2024
Title: SpA Including PsA – Diagnosis, Manifestations, & Outcomes Poster II
Session Type: Poster Session B
Session Time: 10:30AM-12:30PM
Background/Purpose: Radiographs and MRI are both used to diagnose axial spondyloarthritis (axSpA) but they also provide information about morphological and even biomechanical changes in the spinal components. The natural course of degenerative lesions (DLs) in the spine over a long period of observation has not been established in a large group of patients with axSpA. Moreover, it is not well-known which factors are associated with faster progression. Our aim was to investigate the evolution of spinal DLs in axSpA patients over 10 years (10Y) and the factors associated with progression.
Methods: Cervical and lumbar spine radiographs and whole spine MRI at baseline, 5Y and 10Y of patients diagnosed with axSpA in the DESIR cohort were assessed for DLs by three central readers blinded to timepoint and to clinical, laboratory or any other imaging information1. Patients with available imaging (radiographs or MRI) at ≥1 time point were included. DLs were defined at patient level and, for descriptive purposes, in consensus across central readers (≥2 out of 3 readers or average, as appropriate). To assess progression of DLs of both imaging modalities (Table 1) over time, we used multilevel generalised estimating equation (GEE) models considering individual reader data and exchangeable working correlation structure to handle repeated observations over time for each DL. The main variable of interest was time to reflect the annual progression of each lesion. Models were adjusted for sex, HLA-B27 status, BMI, smoking (ever vs never) and job type (no professional activity, white or blue collar) at baseline and biologic therapy exposure (ever vs never) during the 10Y period. Annual change percentage or β-coefficients and 95% confidence intervals (95%CI) were reported.
Results: DLs were available for 330 patients (mean age [SD] 34.5 [8.6] years; 47% men) (Figure 1). There was a mean (SD) of 1.6 (2.5) DLs per patient at baseline on radiographs; this number increased to 3.4 (3.9) at 10Y. On MRI, there was a mean of 7.5 (5.5) DLs per patient at baseline and 11.0 (7.1) at 10Y . A significant progression was mainly detected on radiographs for osteophytes (annual change=2.2%, 95%CI: 1.9-2.7), disc height loss (1.4%, 0.9-1.8), and facet joint osteoarthritis (1.3%, 0.9-1.7). The same trend was detected on MRI for disc protrusion (1.1%, 0.6-1.6), Modic type I (1.0%, 0.7-1.3) and II (0.9%, 0.7-1.2) (Table 1). We observed a statistically significant increase in the number of DLs on radiographs (β=1.8, 95%CI: 1.5-2.1) and MRI (4.2, 3.5-4.8). Factors associated with DLs progression in both imaging modalities were increasing BMI (0.2, 0.1-0.2 on radiographs; 0.4, 0.3-0.4 on MRI) and biologic exposure (0.4, 0.1-0.7 on radiographs; 0.9, 0.3-1.5 on MRI) (Table 2).
Conclusion: In an inception cohort of axSpA degenerative spinal lesions, though common, progress very slowly over 10Y, both on radiographs and MRI. However, this progression appears to be faster in patients with a higher BMI and those exposed to bDMARDs, which likely indicates a more severe form of axSpA.
Reference: 1. de Bruin F et al. RMD Open. 2018;4(1):e000657.
To cite this abstract in AMA style:
Pina Vegas L, Ramiro S, van Lunteren M, Loeuille D, Newsum E, Morizot C, van Gaalen F, SARAUX A, Claudepierre P, Feydy A, van der Heijde D, Reijnierse M. Factors Associated with the Evolution of Degenerative Spinal Lesions in Axial Spondyloarthritis: 10-Year Follow-up of the DESIR Cohort [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/factors-associated-with-the-evolution-of-degenerative-spinal-lesions-in-axial-spondyloarthritis-10-year-follow-up-of-the-desir-cohort/. Accessed .« Back to ACR Convergence 2024
ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-the-evolution-of-degenerative-spinal-lesions-in-axial-spondyloarthritis-10-year-follow-up-of-the-desir-cohort/