Session Type: ACR Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: The association between disease activity and spinal radiographic progression in radiographic axial spondyloarthritis (r-axSpA) has been previously shown in a cohort of patients (pts) not being treated with TNF inhibitors (TNFi).1 We aimed to test the possible association between disease activity and spinal radiographic progression in r-axSpA in a real-life cohort, also including patients treated with TNFi.
Methods: Pts with axial spondyloarthritis (axSpA) fulfilling the modified New York criteria (mNY) were included in this prospective, observational cohort (ALBERTA FORCAST). Clinical and imaging data were collected at baseline and every 2 years up to 10 years of follow-up. Radiographs of the spine were independently scored by 2 central readers and one adjudicator (if disagreement), with known chronological order but blinded to clinical data, using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). To be included, pts had to have ≥ one 2-year interval with data on mSASSS from ≥1 reader available as well as complete data on ASDAS and TNFi exposure at the start of the interval. The association between ASDAS at the start of the interval (t) and mSASSS 2 years later (t+1) was tested in two types of longitudinal GEE models: i. multilevel (2 readers) model with the individual reader scores as outcome (2-level models); ii. Using as outcome averaged scores between readers (1-level models). Both type of models were adjusted for mSASSS at t (autoregression) and for a set of potential confounders defined a priori on clinical grounds (Figure).
Results: In total, 314 pts (442 intervals) were included [74% males, mean symptom duration 17.8 (SD 11.7) years, 83% HLA-B27 positive and 7% previously treated with ≥1 TNFi]. At baseline the mean ASDAS was 2.7 (1.3) and the mean mSASSS 13.8 (18.9). During follow-up 213 (68%) pts received treatment with TNFi in ≥1 visit. Overall, the average 2-year progression was 1.33 (2.68) mSASSS-units per 2-year interval. In the 2-level multivariable model, 1 ASDAS-unit increase at t was associated with an increase of 0.25 mSASSS-units at t+1 [β (95% CI): 0.25 (95%CI 0.10; 0.41)] (Figure). Results were similar using the averaged mSASSS as the outcome [β (95% CI): 0.25 (0.08; 0.43)].
Conclusion: These data indicate that a higher ASDAS is associated with higher spinal radiographic progression in pts with r-axSpA and this is independent of prior treatment with TNFi.
To cite this abstract in AMA style:Sepriano A, Ramiro S, Wichuk S, Chiowchanwisawakit P, MacCosham T, Paschke J, van der Heijde D, Landewé R, Maksymowych W. Higher Disease Activity Is Associated with More Spinal Radiographic Progression in Patients with Axial Spondyloarthritis Independently of Prior Exposure to TNF Inhibitors [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/higher-disease-activity-is-associated-with-more-spinal-radiographic-progression-in-patients-with-axial-spondyloarthritis-independently-of-prior-exposure-to-tnf-inhibitors/. Accessed January 16, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/higher-disease-activity-is-associated-with-more-spinal-radiographic-progression-in-patients-with-axial-spondyloarthritis-independently-of-prior-exposure-to-tnf-inhibitors/