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:
Ankylosing Spondylitis (AS) is debilitating disease
affecting the axial skeleton which is often difficult to diagnose in early
stages. Magnetic Resonance Imaging (MRI) is a valuable tool in detecting early
inflammatory lesions of the spine and monitoring treatment effects. The
longitudinal relationship between changes in MRI inflammation and measures of
clinical disease activity remains uncertain. The aim of this study was to
describe the predictors of change in spinal inflammation and the association
with change in clinical outcomes.
Methods:
129 participants [mean age (years) 41 (17-72); 64 % male]
were studied at baseline and 2 years. MRI of the spine and sacroiliac (SI)
joints were performed at the baseline and follow-up visits. Images were scored,
using the Spondyloarthritis Research Consortium of Canada (SPARCC) 6–discovertebral
unit (6-DVU) and SPARCC method for the SI joints. Radiographs were used to
assess structural damage at the cervical/lumbar spine and SI joints. Disease
activity was assessed using ESR measurements, Bath Ankylosing Spondylitis
Disease Activity Index (BASDAI) and Bath AS disease activity index or by the AS
disease activity score (ASDAS). Functional limitations and disability were
assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the
Health Assessment Questionnaire (HAQ) respectively.
Results:
Table 1 describes the characteristics of the participants
split by the mean spinal MRI score at the baseline visit. A higher spinal MRI
score was significantly associated with older age, male gender, higher BMI,
higher BASMI, BASDAI and BASFI scores, and a more advanced disease at the SI
joint.
Only higher mean BASDAI (p=0.025) and HAQ (p=0.024) scores
significantly predicted an increase in spinal MRI scores over 2 years (data not
shown).
Table 2 describes the association between change in
spinal MRI score and change in clinical outcomes over 2 years. Increases in
BASDAI, BASFI and ASDAS scores, but not BASMI, were independently associated
with an increase in the severity of the spinal MRI scores.
Conclusion:
In summary, only high BASDAI and HAQ scores
predicted an increase in MRI spinal inflammation over 2 years. Increase in MRI
spinal inflammation in turn, was independently associated with worsening
clinical outcomes such as BASDAI, BASFI and ASDAS. These results suggest that
MRI spinal inflammation mirrors clinical outcomes over 2 years.
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Table 1: Baseline characteristics of participants split by mean spine MRI score* |
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Mean total spine score <9.9 (n=69) |
Mean total spine Score ≥ 9.9 (n=60) |
P-Value |
|
Age (years) |
37.1(13.7) |
44.1(12.9) |
0.006
|
|
Males (%) |
52 |
80 |
0.001
|
|
BMI |
25.4(3.2) |
27.2(4.9) |
0.033
|
|
BASMI score (mean) |
2.1(1.5) |
2.6(1.5) |
0.034
|
|
BASDAI score (mean) |
3.6(2.3) |
4.5(2.3) |
0.033 |
|
BASFI score (mean) |
2.9(2.4) |
3.3(2.7) |
0.032 |
|
HAQ score (mean) |
5.6 |
5.8 |
0.838
|
|
Total SI joint MRI score (mean) |
12.3(13.5) |
18.9(20.6) |
0.070
|
|
Total SI joint radiographic score (mean) |
3.0(2.6) |
4.5(2.5) |
0.001
|
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Total cervical spine radiographic score (mean) |
3.6(6.5) |
6.5(10.1) |
0.104
|
|
Total lumbar spine radiographic score (mean) |
3.0(7.7) |
4.4(9.5) |
0.402
|
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*Mean (SD) except for percentages. P-values determined by t-test or x2 test (where appropriate) |
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Table 2: Association between change in spine MRI score and change in clinical outcomes |
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Change in spine MRI score |
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Unadjusted β (95%CI) |
Adjusteda β (95%CI) |
Adjustedb β (95%CI) |
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Change in BASMI |
+0.99 (+0.06, +1.91) |
+1.02 (-0.01, +2.05) |
+1.31 (-0.44, +3.08) |
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Change in BASDAI |
+0.59 (+0.26, +0.92) |
+0.69 (+0.32, +1.06) |
+0.89 (+0.31, +1.49) |
|
Change in BASFI |
+0.77 (+0.26, +1.28) |
+0.73 (+0.16, +1.30) |
+0.94 (+0.29, +1.71) |
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Change in ASDAS^ |
+1.21 (+0.07, +2.16) |
+1.22 (+0.08, +2.10) |
+1.54 (+0.22, +2.87) |
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a adjusted for age, sex and bmi badjusted for age, sex, bmi, duration of disease, ESR, NSAID treatment and anti-TNF treatment ^ASDAS score calculated using ESR
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To cite this abstract in AMA style:
Khan HI, Chou L, Lewis P, Wilson A, Millner J, Zochling J. Predictors and Clinical Factors Associated with Change in Spinal Inflammation Assessed on MRI over 2 Years: Data from Tasmanian Ankylosing Spondylitis Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/predictors-and-clinical-factors-associated-with-change-in-spinal-inflammation-assessed-on-mri-over-2-years-data-from-tasmanian-ankylosing-spondylitis-study/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-and-clinical-factors-associated-with-change-in-spinal-inflammation-assessed-on-mri-over-2-years-data-from-tasmanian-ankylosing-spondylitis-study/