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: Assessing radiographic progression in ankylosing spondylitis (AS) is challenging. The results regarding the effect of tumor necrosis factor-alpha (TNF-α) blocking therapy on spinal radiographic progression are difficult to interpret due to methodological limitations. Our aim was to evaluate spinal radiographic progression over 2 to 8 years of follow-up in a large cohort of AS patients treated with TNF-α inhibitors.
Methods: Consecutive patients from the Groningen Leeuwarden AS (GLAS) cohort who started treatment with TNF-α inhibitors because of active disease were included. Available lateral cervical and lumbar radiographs at baseline and after at least one follow-up visit at 2, 4, 6, or 8 years were scored in chronological time order by two trained and independent readers using the modified Stoke AS Spine Score (mSASSS). Descriptive statistics for 0-2, 0-4, 0-6, 0-8 years and generalized estimating equations (GEE) for complete cases over 8 years were used to evaluate spinal radiographic progression.
Results: In total, 193 GLAS patients were included; 69% were male, mean age was 42 ± 11 years, median symptom duration was 15 years (range 1-53), 78% were HLA-B27 positive, and median baseline mSASSS was 2.5 (range 0-68).
The mean spinal radiographic progression ranged from 1.7 ± 2.8 over the first 2 years to 7.0 ± 5.3 over 8 years of follow-up (Table 1). GEE analysis of complete cases over 8 years (n=19) revealed that the logarithmic time model had the best fit for the data. This model showed a deflection in mSASSS over time; the estimated progression rate was 2.3, 1.4, 1.0 and 0.8 during 0-2, 2-4, 4-6, and 6-8 years, respectively.
Conclusion: This observational study showed overall slow spinal radiographic progression in AS patients treated with TNF-α inhibitors. In a limited number of patients, complete case analysis indicated a deflection in spinal radiographic progression during 8 years of follow-up.
|
Table 1. Spinal radiographic progression in AS patients who started treatment with TNF-α inhibitors. |
|||
|
|
N |
Mean ± SD |
Median (range) |
|
All included patients |
|||
|
Baseline mSASSS |
193 |
9.9 ± 15.5 |
2.5 (0.0-67.8) |
|
mSASSS progression 0-2yr |
168 |
1.7 ± 2.8 |
0.0 (0.0-15.0) |
|
mSASSS progression 0-4yr |
135 |
3.4 ± 4.6 |
1.7 (0.0-19.8) |
|
mSASSS progression 0-6 yr |
83 |
4.4 ± 5.1 |
2.5 (0.0-22.8) |
|
mSASSS progression 0-8yr |
41 |
7.0 ± 6.3 |
6.2 (0.0-22.0) |
|
Complete cases over 8 years |
|||
|
Baseline mSASSS |
19 |
10.0 ± 12.9 |
5.4 (0.0-47.5) |
|
mSASSS progression 0-2yr |
19 |
2.2 ± 2.7 |
1.0 (0.0-7.0) |
|
mSASSS progression 2-4yr |
19 |
1.6 ± 2.1 |
0.5 (0.0-7.0) |
|
mSASSS progression 4-6yr |
19 |
0.9 ± 1.3 |
0.0 (0.0-4.7) |
|
mSASSS progression 6-8yr |
19 |
0.9 ± 1.4 |
0.0 (0.0-4.7) |
To cite this abstract in AMA style:
Maas F, Arends S, Essers I, Brouwer E, van der Veer E, Wink F, Efde M, Bootsma H, Spoorenberg A. Slow Spinal Radiographic Progression in Patients with Ankylosing Spondylitis Treated with TNF Inhibitors [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/slow-spinal-radiographic-progression-in-patients-with-ankylosing-spondylitis-treated-with-tnf-inhibitors/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/slow-spinal-radiographic-progression-in-patients-with-ankylosing-spondylitis-treated-with-tnf-inhibitors/