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Abstract Number: 1326

Which Score to Use for Radiographic Damage Assessment of the Spine in (early) Axial Spondyloarthritis? Two-Year Data from the DESIR Cohort

Sofia Ramiro1, Pascal Claudepierre2, Rosaline van den Berg3, Victoria Navarro-Compán4, Antoine Feydy5, Maria-Antonietta d'Agostino6, Damien Loeuille7, Maxime Dougados8, Monique Reijnierse9 and Désirée van der Heijde1, 1Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 2Rheumatology, Université Paris Est Créteil, Créteil, France, 3Leiden University Medical Center, Leiden, Netherlands, 4Rheumatology, University Hospital La Paz, Madrid, Spain, 5Paris Descartes University, Radiology B department, Cochin Hospital, Paris, France, 6Rheumatology, Versailles-Saint Quentin en Yvelines University, Boulogne-Billancourt, France, 7Rheumatology, Nancy University Hospital, Nancy, France, 8Rheumatology Department, Cochin hospital, Paris-Descartes University, Paris, France, 9Radiology, Leiden University Medical Center, Leiden, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Assessment, Outcome measures, radiography and spondylarthritis

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Session Information

Date: Monday, November 9, 2015

Session Title: Imaging of Rheumatic Diseases Poster II: X-ray, MRI, PET and CT

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Several scores have been developed to assess radiographic damage in AS. However, we do not know how they perform in early phases of the disease. Our aim was to compare the performance of different radiographic scores of the spine in patients with early axial spondyloarthritis (axSpA). 

Methods: Yearly radiographs from a 2-year follow-up of the DESIR cohort from patients fulfilling the ASAS axSpA criteria have been used. Spinal (cervical, thoracic and lumbar) and sacro-iliac (SI) radiographs were scored independently by two readers for the presence of the different damage aspects enabling the calculation of different scores: mSASSS (0-72), SASSS (0-72), RASSS (0-84) and BASRI-spine (0-12), using the averaged scores between readers per vertebral corner (VC)/SI joints. Additionally, a variation of the BASRI-spine was computed adding an overall score for the thoracic spine (0-16). Following the OMERACT proposal, scores were compared with regard to truth, discrimination (sensitivity to change and reliability) and feasibility. Status (at baseline of first x-ray available) and 2-year progression scores were calculated for each of the methods as well as the proportion of patients with any change (change>0). 

Results: In total, 486 patients (mean age 33.0 (SD 8.6) years, 50% males) had at least one radiograph available. At baseline, scores ranged from 0 and 21.6 for the mSASSS (30% of the maximum of the scale), 20.6 for RASSS (25% of maximum), 6 for SASSS (8% of maximum), 8.5 for BASRI-spine (71% of maximum) and 10.25 for BASRI-spine with thoracic spine (64% of maximum). Status scores and 2-year progression scores available are shown in the table. The proportion of patients with any 2-year change was the following: 9.9% for mSASSS, 10.7% for RASSS, 6.9% for SASSS, 19.2% for BASRI-spine and 22.0% for BASRI-spine with thoracic spine. Absolute change scores (table) showed that the mSASSS and RASSS captured most change. 2-year RASSS progression occurred in a balanced way across segments (cervical, thoracic and lumbar), when taking the number of VCs included per segment. All scores had acceptable reliability. In what concerns feasibility, all scores seemed to be feasible, but the BASRI-spine (+/- thoracic spine) was more frequently missing (up to 15% of the cases), as it requires also the availability of SI joints. 

Table – Status and 2-year progression for the different radiographic scoring methods

 

mSASSS

mean (SD)

n = 481

RASSS

mean (SD)

n = 481

SASSS

mean (SD)

n = 483

BASRI spine

mean (SD)

n = 447

BASRI spine with thoracic

mean (SD)

n = 442

STATUS SCORES

Total score

0.57 (2.37)

0.54 (2.34)

0.17 (1.03)

1.35 (1.62)

1.46 (1.80)

Cervical segment

0.36 (1.69)

0.34 (1.66)

—

0.16 (0.55)

0.17 (0.55)

Lumbar segment

0.21 (1.09)

0.16 (1.04)

0.17 (1.03)

0.18 (0.54)

0.19 (0.55)

Lumbar segment with thoracic segment included

—

0.19 (1.13)

—

—

—

Thoracic segment

—

0.03 (0.28)

—

—

0.09 (0.38)

Lumbar anterior

—

—

0.16 (1.03)

—

—

Lumbar posterior

—

—

0.00 (0.02)

—

—

SI joints

—

—

—

1.00 (1.13)

1.00 (1.13)

2-YEAR PROGRESSION SCORES

 

mSASSS

n = 322

RASSS

n = 319

SASSS

n = 335

BASRI spine

n = 287

BASRI spine with thoracic

n = 268

Total score

0.27 (1.57)

0.36 (1.74)

0.15 (0.78)

0.05 (0.72)

0.07 (0.83)

Cervical segment

0.19 (1.16)

0.17 (1.18)

—

0.04 (0.36)

0.03 (0.35)

Lumbar segment

0.08 (0.63)

0.13 (0.66)

0.15 (0.78)

0.01 (0.40)

0.02 (0.35)

Lumbar segment with thoracic segment included

—

0.18 (0.84)

—

—

—

Thoracic segment

—

0.06 (0.38)

—

—

0.00 (0.32)

Lumbar anterior

—

—

0.13 (0.65)

—

—

Lumbar posterior

—

—

0.02 (0.33)

—

—

SI joints

—

—

—

0.01 (0.36)

0.01 (0.37)

Conclusion: The existing scoring methods to assess radiographic damage performed well in early phases of axSpA. The mSASSS and RASSS captured most change, but there was no gain in additionally scoring the thoracic spine for the RASSS. The mSASSS remains the most sensitive and most adequate scoring method in axSpA, including early phases of the disease.


Disclosure: S. Ramiro, None; P. Claudepierre, None; R. van den Berg, None; V. Navarro-Compán, None; A. Feydy, None; M. A. d'Agostino, None; D. Loeuille, None; M. Dougados, None; M. Reijnierse, None; D. van der Heijde, None.

To cite this abstract in AMA style:

Ramiro S, Claudepierre P, van den Berg R, Navarro-Compán V, Feydy A, d'Agostino MA, Loeuille D, Dougados M, Reijnierse M, van der Heijde D. Which Score to Use for Radiographic Damage Assessment of the Spine in (early) Axial Spondyloarthritis? Two-Year Data from the DESIR Cohort [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/which-score-to-use-for-radiographic-damage-assessment-of-the-spine-in-early-axial-spondyloarthritis-two-year-data-from-the-desir-cohort/. Accessed May 30, 2023.
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