Session Information
Date: Monday, November 9, 2015
Title: Spondylarthropathies and Psoriatic Arthritis - Comorbidities and Treatment Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Syndesmophyte formation in ankylosing spondylitis (AS) is still insufficiently understood. Previous studies have suggested an association between MRI vertebral corner inflammation (VCI) and vertebral corner fat deposition (VCFD) and the subsequent development of radiographic syndesmophytes (SYN). Our aim was to investigate the relationship between MRI inflammation and fat deposition at a VE and the development of a SYN at the same VE.
Methods: A random 80% sample of the ASSERT database was used for this analysis. ASSERT was a 24-week (wk) RCT comparing infliximab monotherapy and placebo in patients with active AS, with an open extension until 102wks with all patients on infliximab. Spinal MRIs (T1-weighted and STIR images) at baseline, 24wks and 102wks were assessed by 2 readers independently who scored each VE for the presence or absence of VCI and VCFD. Spinal X-rays (baseline and 102wks) were scored by 2 different readers independently using the mSASSS. Data were analysed at the VE level in the 24 VEs assessed by the mSASSS (anterior VEs of the cervical and lumbar spine), using a multi-level approach to adjust for within-patient correlation and MRI reader (GEE for binomial outcomes). Particular emphasis was on a sequence analysis, which aimed at the specific sequence VCI→VCFD→SYN. The following variables were considered potential covariates and adjusted for when appropriate: treatment, gender, presence of SYN/ankylosis at baseline (patient level), HLA-B27, baseline- and time-averaged BASDAI/ASDAS/CRP, age, BMI and disease duration. Readers were unaware of the patient’s identity, their treatment, the scores of the other imaging modality, and the true time-order of the images (fully unbiased scores).
Results: After excluding VEs with SYN or ankylosis at baseline and non-evaluable VEs, data from 3079 to 3363 MRI and X-ray paired case-definitions, belonging to up to 177 patients, were analysed. The presence of VCI (adjusted (ad)OR=1.98-1.93) as well as the presence of VCFD (adOR=1.59-2.32) at any time point (TP) was significantly associated with the development of a new SYN. The strength of the association increased by combining VCI and VCFD, both when analysing VEs with VCI and VCFD present across any of the three TP (simultaneously or not) (adOR=2.29-2.73) and also when analysing only newly developed VCFD preceded by inflammation in the same VE at a previous TP (adOR=2.45-3.01) (sequence analysis, VCI→VCFD→SYN). The complete absence of both VCI and VCFD across the three TP was protective for the development of a new SYN (aOR= 0.45-0.62) (Table). However, a large proportion of SYN developed in VEs without MRI inflammation or fat degeneration at any of the three TP (42-66%, depending on the combination of MRI- and X-ray reader).
Conclusion: Both VCI and VCFD contribute to the development of a new SYN in AS, especially if VCI precedes VCFD. But this typical sequence only partially explains the development of new SYN in AS.
|
Table. Multivariable GEE results (adjOR; 95% CI) for the outcome SYN formation according to X-ray reader 1 (R1) or/and reader 2 (R1) |
|||||
|
Variables |
SYN formation according to R1 or R2 |
||||
|
VCI at any TP |
1.98 (1.49, 2.62) |
– |
– |
– |
– |
|
VCFD at any TP |
– |
2.32 (1.85, 2.91) |
– |
– |
– |
|
New VCFD preceded by VCI |
– |
– |
2.45 (1.66, 3.60) |
– |
– |
|
Sequential or simultaneous presence of VCI and VCFD across the 3 TP |
– |
– |
– |
2.73 (2.00, 3.74) |
– |
|
Absence of VCI or VCFD across the 3 TP |
– |
– |
– |
– |
0.45 (0.36, 0.56) |
|
Treatment (infliximab) |
1.03 (0.75, 1.41) |
1.09 (0.80, 1.49) |
1.02 (0.74, 1.40) |
1.05 (0.77, 1.44) |
1.04 (0.76, 1.44) |
|
Gender (male) |
3.30 (1.94, 5.60) |
3.02 (1.79, 5.10) |
3.39 (2.01, 5.74) |
3.36 (1.98, 5.70) |
3.00 (1.77, 5.08) |
|
SYN/ankylosis at baseline |
2.91 (2.00, 4.25) |
2.82 (1.92, 4.13) |
2.95 (2.02, 4.29) |
2.89 (1.98, 4.21) |
2.81 (1.91, 4.11) |
|
Variables |
SYN formation according to R1 and R2 |
||||
|
VCI at any TP |
1.93 (1.22, 3.05) |
|
|
|
|
|
VCFD at any TP |
– |
1.60 (1.10, 2.33) |
|
|
|
|
New VCFD preceded by VCI |
– |
– |
3.01 (1.76, 5.13) |
|
|
|
Sequential or simultaneous presence of VCI and VCFD across the 3 TP |
– |
– |
|
2.29 (1.37, 3.83) |
|
|
Absence of VCI or VCFD across the 3 TP |
– |
– |
|
|
0.62 (0.43, 0.89) |
|
Treatment (infliximab) |
1.29 (0.68, 2.44) |
1.26 (0.66, 2.39) |
1.28 (0.67, 2.43) |
1.32 (0.70, 2.50) |
1.30 (0.68, 2.49) |
|
Gender (male) |
2.50 (0.83, 7.51) |
2.36 (0.80, 6.97) |
2.48 (0.85, 7.26) |
2.47 (0.83, 7.33) |
2.29 (0.77, 6.77) |
|
SYN/ankylosis at baseline |
4.11 (1.56, 10.8) |
4.22 (1.58, 11.2) |
4.19 (1.60, 11.0) |
4.14 (1.58, 10.9) |
4.18 (1.56, 11.2) |
To cite this abstract in AMA style:
Machado P, Baraliakos X, van der Heijde D, Braun J, Landewé R. MRI Vertebral Corner Inflammation Followed By Fat Deposition Is the Strongest Contributor to the Development of New Bone at the Same Vertebral Corner: A Multi-Level Longitudinal Analysis in Patients with Ankylosing Spondylitis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/mri-vertebral-corner-inflammation-followed-by-fat-deposition-is-the-strongest-contributor-to-the-development-of-new-bone-at-the-same-vertebral-corner-a-multi-level-longitudinal-analysis-in-patients-w/. Accessed .« Back to ACR/ARHP Annual Meeting 2015
ACR Meeting Abstracts - https://acrabstracts.org/abstract/mri-vertebral-corner-inflammation-followed-by-fat-deposition-is-the-strongest-contributor-to-the-development-of-new-bone-at-the-same-vertebral-corner-a-multi-level-longitudinal-analysis-in-patients-w/