DESIR队列：早期axSpA的脊柱放射学进展

DESIR队列：早期axSpA的脊柱放射学进展

EULAR2015; PresentID:
FRI0234

SPINAL
RADIOGRAPHIC PROGRESSION IN EARLY AXIAL SPONDYLOARTHRITIS: DATA
FROM THE DESIR COHORT

S.
Ramiro^1,*, D. van der Heijde¹, R. van den
Berg¹, V. Navarro-Compán¹, A.
Feydy², M. A. d'Agostino³, D.
Loeuille⁴, M. Dougados⁵, M.
Reijnierse⁶, P. Claudepierre⁷

¹Rheumatology, Leiden
University Medical Center, Leiden, Netherlands,
²Radiology, Paris Descartes University, Paris,
³Rheumatology, Université Versailles-Saint Quentin en
Yvelines Boulogne-Billancourt, Boulogne, ⁴Rheumatology,
University of Nancy, Nancy, ⁵Rheumatology, Université
Paris Descartes, Paris, France, ⁶Radiology, Leiden
University Medical Center, Leiden, Netherlands,
⁷Rheumatology, Université Paris Est Créteil, Créteil,
France

Background: The
development of radiographic damage over time has been investigated
in patients with ankylosing spondylitis, but not yet in early axial
spondyloarthritis (axSpA). DESIR is an inception cohort, following
patients with inflammatory back pain (IBP) of short duration, and
provides an attractive setting to investigate the development of
radiographic damage in axSpA. We have recently shown that the
modified Stoke in Ankylosing Spondylitis Spine Score (mSASSS) is
the most sensitive and adequate scoring method in (early)
axSpA.

Objectives: To
analyse the development and progression of radiographic damage in
the spine in patients with IBP and early axSpA.

Methods:
Patients with IBP for no longer than 3 years and with a clinical
suspicion for axSpA were included in the DESIR cohort. Yearly
cervical and lumbar radiographs from the first 2 years of follow-up
were used in this analysis. Patients with radiographs available
allowing the estimation of at least one (1-year or 2-year)
progression interval were included in this analysis. Two trained
readers independently scored the radiographs according to the
mSASSS (0-72). Scores per vertebral corner were averaged between
the readers. One-year (baseline-year 1 and year 1-year 2) and
two-year (baseline-year 2) progression scores were computed.
Progression was assessed in each of the different subgroups of
patients defined according to the fulfillment of the ASAS axSpA
criteria, imaging arm (modified New York Criteria (mNYC) +/- and
MRI positivity (according to the ASAS definition)), and clinical
arm only (+/- positive CRP) at baseline. In addition, patients were
grouped according to presence of baseline
syndesmophytes.

Results: In
total, 608 patients (mean age 36.0 (SD 8.8) years, 47% males, 74%
fulfilling ASAS axSpA criteria) were included. At baseline, the
average mSASSS was 0.62 (2.74). From these patients, 929 one-year
mSASSS progression intervals could be obtained and 441 two-year
progression intervals. Patients fulfilling the ASAS axSpA criteria
had no average 0.27 (1.57) mSASSS-units progression in 2 years
(0.19 (1.16) in the cervical spine and 0.08 (0.63) in the lumber
spine), whereas those not fulfilling the criteria showed a
progression of 0.08 (1.03) units. Patients fulfilling the imaging
arm had a progression of 0.39 (2.00) mSASSS-units per 2 years.
Within this subgroup of patients, patients fulfilling the mNYC and
with a negative MRI had the highest progression, followed by those
mNYC+ and MRI+ and lastly those mNYC- but with MRI+ (Table).
Patients fulfilling only the clinical arm of the ASAS criteria had
a progression of 0.11 (0.60) mSASSS-units per 2 years. Patients
with baseline syndesmphytes (across all subgroups) had a 2-year
progression of 0.78 (2.75) mSASSS-units.

Conclusions:
Development of spinal radiographic progression can be captured in a
cohort of patients with early axSpA within a 2-year follow-up.
Progression is higher in patients fulfilling the mNYC and also in
patients with baseline syndesmophytes.

背景：已有研究探讨强直性脊柱炎(AS)患者放射损伤随时间的进展，但早期axSpA这方面还是空白。DESIR队列是一个起始队列,
纳入短病程炎性腰背痛(IBP)患者，为探讨axSpA放射损伤进展提供了一个很好的机会。我们最近的研究表明改良斯托克强直性脊柱炎脊柱评分（mSASSS）是(早期)axSpA最敏感和最合适的评分方法。

目的：分析IBP和早期axSpA患者脊柱放射损伤的发生和发展。

方法：DESIR队列纳入了炎性腰背痛病程不超过3年且临床疑诊axSpA的患者。患者前2年每年随访一次的颈椎和腰椎X线片。所纳入分析的患者至少有1年或2年的放射学进展评估。两名受过培训的阅片师分别独立地对X线片进行mSASSS评分（0-72分）。每个椎角的得分取两名阅片师的平均值。计算1年（基线-1年，1年-2年）和2年（基线-2年）的放射学进展评分。根据基线时是否符合ASAS
axSpA分类标准、影像支（改良纽约修订标准(mNYC)和/或ASAS定义的MRI骶髂关节炎阳性）、临床支（CRP
+/-），对各亚组的放射学进展进行分层分析。另外，还根据基线是否存在骨赘进行亚组分析。

结果：共计纳入608名患者（平均年龄36岁，（SD:
8.8），47%为男性，74%符合ASAS
axSpA分类标准）。基线时，平均mSASSS为0.62（2.74）。在这些患者中，1年间观察mSASSS总进展为929，2年间总进展为441。符合ASAS
axSpA标准的患者在2年间mSASSS平均进展为0.27（1.57）单位（颈椎0.19（1.16），腰椎0.08（0.63））。而不符合ASAS
axSpA标准的患者2年间mSASSS平均进展0.08单位（1.03）。符合影像支的患者两年间mSASSS平均进展0.39单位（2.00）。符合mNYC并且MRI阴性这一亚组的患者进展最快，其次是符合mNYC并且MRI阳性的患者，而MRI阳性但不符合mNYC的患者进展最慢（见表）。仅符合ASAS标准临床支的患者每2年mSASSS进展单位为0.11（0.60）。基线时存在骨赘的患者，不论亚组如何，每2年mSASSS进展单位为0.78（2.75）。

结论：在早期axSpA患者2年的随访中可以观察到脊柱放射学的进展。符合纽约修订标准以及基线存在骨赘的患者的放射学进展较快。

表.
2年间脊柱放射学进展(分为1年间和2年间)

	亚组	1年间mSASSS 进展均值(SD) n=929*	2年间mSASSS 进展均值(SD) n=441*
ASAS标准	ASAS+	0.09 (1.01), n=664	0.27 (1.57), n=322
	ASAS-	0.08 (0.90), n=252	0.08 (1.03), n=116
ASAS标准 影像支	MRI+ mNYC+	0.14 (1.66), n=180	0.38 (2.39), n=88
	MRI+ mNYC-	0.05 (0.48), n=135	0.18 (0.93), n=63
	MRI- mNYC+	0.28 (1.12), n=72	0.82 (2.33), n=34
ASAS标准 临床支	仅CRP+	0.01 (0.29), n=39	0.14 (0.50), n=21
	仅CRP-	0.04 (0.51), n=238	0.10 (0.61), n=116
基线骨赘	存在+	0.26 (1.65), n=216	0.78 (2.75), n=97
	不存在-	0.03 (0.64), n=713	0.06 (0.67), n=344

* n指的是各组病人在1年间和2年间放射学进展总数，或者为列合计，或者为行合计(即各亚组)