Abstract
BackgroundThis study aimed to investigate whether the presence of low bone mineral density (BMD) in patients with axial spondyloarthritis (axSpA) predicts formation of new syndesmophytes over 2 years.MethodsOne hundred and nineteen patients fulfilling the imaging arm of the Assessment of SpondyloArthritis International Society axSpA criteria were enrolled. All patients were under 50 years of age. The modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) was assessed by two trained readers blinded to the patients’ data. BMD (lumbar spine, femoral neck or total hip) at baseline was assessed using dual-energy absorptiometry. Low BMD was defined as Z score ≤ − 2.0. Spinal radiographic progression was defined as worsening of the mSASSS by ≥ 2 points over 2 years. Logistic regression analyses were performed to identify predictors associated with development of new syndesmophytes and spinal radiographic progression.ResultsAt baseline, 19 (16%) patients had low BMD. New syndesmophytes had developed in 22 (21%) patients at 2-year follow-up. New syndesmophyte formation after 2 years occurred more in patients with low BMD than in those with normal BMD (p = 0.047). In the multivariable analysis, current smoking, existing syndesmophytes and low BMD at baseline were associated with spinal radiographic progression (OR (95% CI) 3.0 (1.1, 7.7), 4.6 (1.8, 11.8) and 3.6 (1.2, 11.2), respectively). The presence of syndesmophytes at baseline and low BMD were predictors of new syndesmophytes over the following 2 years (OR (95% CI) 5.5 (2.0, 15.2) and 3.6 (1.1, 11.8), respectively).ConclusionsLow BMD and existing syndesmophytes at baseline were independently associated with the development of new syndesmophytes in young axSpA patients.
Highlights
This study aimed to investigate whether the presence of low bone mineral density (BMD) in patients with axial spondyloarthritis predicts formation of new syndesmophytes over 2 years
Bone mineral density (BMD) using dual-energy absorptiometry (DXA) and lateral radiographs of the cervical and lumbar spine were assessed at the time of enrolment, and demographic data were collected at the time of BMD assessment
Data presented as n (%) or mean ± standard deviation BMD bone mineral density, BMI body mass index, axSpA axial spondyloarthritis, BASDAI Bath Ankylosing Spondylitis Disease Activity Index, BASFI Bath Ankylosing Spondylitis Functional Index, ESR erythrocyte sedimentation rate, CRP C-reactive protein, ASDAS Ankylosing Spondylitis Disease Activity Score, mSASSS modified Stoke Ankylosing Spondylitis Spinal Score, Non-steroidal antiinflammatory drug (NSAID) nonsteroidal anti-inflammatory drug, TNF tumour necrosis factor associated with significant spinal progression (OR 3.0, Odds ratio (OR) 4.6 and OR 3.6, respectively)
Summary
This study aimed to investigate whether the presence of low bone mineral density (BMD) in patients with axial spondyloarthritis (axSpA) predicts formation of new syndesmophytes over 2 years. AxSpA includes the subtypes ankylosing spondylitis (AS) and non-radiographic axSpA (nr-axSpA) These separate entities are discriminated by the structural damage to the sacroiliac joints visible on conventional X-ray images [1]. In a recent study, persisting high disease activity according to the Ankylosing Spondylitis Disease Activity Score (ASDAS) was found to be associated with accelerated radiographic spinal progression in early axSpA patients [7]. This advocates the early use of anti-inflammatory treatment in patients with early and active disease, in the hope that decreasing the disease activity will slow down the radiographic progression. Identification of the predictors of spinal progression at baseline is important for clinical decision-making on aggressive anti-inflammatory treatment
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