Abstract
BackgroundTo evaluate the performance of the extended modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) incorporating information from anteroposterior (AP) lumbar radiographs as compared to the conventional mSASSS in detection of radiographic spinal progression in patients with axial spondyloarthritis (axSpA)MethodsA total of 210 patients with axSpA, 115 with radiographic axSpA (r-axSpA), and 95 with non-radiographic axSpA (nr-axSpA), from the GErman SPondyloarthritis Inception Cohort (GESPIC), were included in the analysis based on the availability of spinal radiographs (cervical spine lateral, lumbar spine lateral, and AP views), at baseline and year 2. Two trained readers independently scored lateral cervical and lumbar spine images according to the mSASSS system (0–3 per vertebral corner, 0–72 in total). In addition, all vertebral corners of vertebral bodies visible on lumbar AP radiographs (lower T12 to upper S1) were assessed according to the same scoring system that resulted in a total range for the extended mSASSS from 0 to 144. Reliability and sensitivity to detect radiographic spinal progression of the extended mSASSS as compared to the conventional mSASSS were evaluated.ResultsThe reliability of conventional and extended scores was excellent with intraclass correlation coefficients (ICCs) of 0.926 and 0.927 at baseline and 0.920 and 0.933 at year 2, respectively. The mean ± SD score for mSASSS and extended mSASSS at baseline were 4.25 ± 8.32 and 8.59 ± 17.96, respectively. The change score between baseline and year 2 was 0.73 ± 2.34 and 1.19 ± 3.73 for mSASSS and extended mSASSS, respectively. With the extended mSASSS, new syndesmophytes after 2 years were detected in 4 additional patients, new syndesmophytes or growth of existing syndesmophytes in 5 additional patients, and progression by ≥ 2 points in the total score in 14 additional patients meaning a 25%, 28%, and 46% increase in the proportion of patients with progression according to the respective definition as compared to the conventional score.ConclusionsIncorporation of lumbar AP radiographs in the assessment of structural damage in the spine resulted into detection of additional patients with radiographic spinal progression not captured by the conventional mSASSS score.
Highlights
Axial spondyloarthritis can be classified into radiographic SpA (r-axial spondyloarthritis (axSpA), known as ankylosing spondylitis—Ankylosing spondylitis (AS)) or non-radiographic SpA depending on the presence or absence of definite radiographic sacroiliitis according to the grading system of the modified New York criteria [1]
With a linear regression analysis, we investigated the relationship between both scores and spinal mobility and function
AP lumbar radiograph is a routine projection in the clinical practice, it increases the costs of the radiographic investigation of the spine by approximately 50% and the time required for the reading according to the extended modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) by 50–100% as compared to conventional mSASSS
Summary
Axial spondyloarthritis (axSpA) can be classified into radiographic SpA (r-axSpA, known as ankylosing spondylitis—AS) or non-radiographic SpA (nr-axSpA) depending on the presence or absence of definite radiographic sacroiliitis according to the grading system of the modified New York (mNY) criteria [1]. New bone formation with development of syndesmophytes between vertebrae represents the morphological substrate of structural damage in the spine in axSpA. Since development of structural damage is usually assessed on conventional radiographs, it is referred to as radiographic spinal progression. Structural damage in the spine and disease activity are two major determinants of spinal mobility and physical function in axSpA [2,3,4]. The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) [5] is considered as the gold standard for assessment of structural damage in the spine in axSpA [6]. To evaluate the performance of the extended modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) incorporating information from anteroposterior (AP) lumbar radiographs as compared to the conventional mSASSS in detection of radiographic spinal progression in patients with axial spondyloarthritis (axSpA)
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