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THU0450 IDENTIFICATION OF PREDICTORS OF RADIOGRAPHIC SACROILIITIS PROGRESSION IN NON-RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS AND ANKYLOSING SPONDYLITIS D. Poddubnyy 1,*, M. Rudwaleit 2, H. Haibel 1, J. Listing 3, E. Märker-Hermann 4, H. Zeidler 5, J. Braun 6, J. Sieper 1 1Charité Universitätsmedizin, Berlin, 2Ev. Krankenhaus Hagen-Haspe, Hagen, 3DRFZ, Berlin, 4Dr. Horst Schmidt Kliniken, Wiesbaden, 5Medizinische Hochschule, Hannover, 6Rheumazentrum Ruhrgebiet, Herne, Germany Background: The current concept of axial spondyloarthritis (SpA) considers non-radiographic axial SpA (nrSpA) and ankylosing spondylitis (AS) as two stages of one disease implying that sacroiliitis as seen on x-rays is evolving over time. While there has been considerable interest recently in the rate of progression of structural damage in the spine of AS patients, only limited data are available regarding the rates and predictors of progression of radiographic sacroiliitis. Objectives: The objective of the study was identification of predictors of radiographic sacroiliitis progression predictors in a cohort of patients with axial SpA over a period of two years. Methods: 210 patients with axial SpA (115 with
AS according to the modified New York criteria and 95 with nrSpA)
from the German Spondyloarthritis Inception Cohort (GESPIC) were
selected for this analysis based on availability of radiographs at
baseline and after 2 years of follow-up. Results: Progression of sacroiliitis over two
years by at least one grade at one side in opinion of both readers
was found in 16.8% of patients with nrSpA and in 8.7% of patients
with AS. At the same time, there was an improvement of sacroiliitis
by at least one grade in the opinion of both readers in 6.3% and
4.3% of patients with nrSpA and AS, respectively.
The strongest predictor of radiographic sacroiliitis progression over 2 years by at least one grade in the opinion of both readers in both nrSpA and AS was an elevated C-reactive protein (CRP) level at baseline (OR=3.7, p=0.023 and OR=5.1, p=0.048, respectively). Importantly, the elevated level of CRP was also a significant predictor of progression of nrSpA to AS fulfilling the modified New York criteria (OR=4.10, p=0.032). The presence of definite structural damage at baseline (sacroiliitis grade 2 unilaterally in the opinion of both readers) also showed an association with progression to AS, although the level of statistical significance was not reached (OR=3.00, p=0.092). Factors such as age, sex, HLA-B27 status, BASDAI and BASFI values, presence of peripheral arthritis, enthesitis, uveitis, family history of SpA, inflammatory bowel disease, therapy with NSAIDs and DMARDs showed no clear influence on the progression of radiographic sacroiliitis. Conclusions: Progression of radiographic sacroiliitis by at least one grade after two years occurs in a relatively small percentage of patients with axial SpA (10.5% for nrSpA and 4.4% for AS). An elevated level of CRP was found to be a strong positive predictor of sacroiliitis progression in nrSpA and AS. |
nr-axial-SpA与强柱病人在2年间出现X线骶髂关节炎的基线预测因素 D. Poddubnyy, EULAR 2011. Present No: THU0450 背景：目前对中轴脊柱关节病（SpA）的概念认为无放射学改变脊柱关节病患者(nrSpA)与强直性脊柱炎患者(AS)是一种疾病的两个阶段，这提示随时间进展，出现骶髂关节炎X线表现迟早会出现。虽然对AS患者脊柱结构损害进展的比率已有相当大的关注，但关于放射学骶髂关节炎进展的比率和预测因素，数据仍十分有限。 目的：本研究目的是对中轴脊柱关节病患者检测在2年间出现X线骶髂关节炎进展的预测因素。 方法：210名中轴脊柱关节病患者（115名强直性脊柱炎，符合修订的纽约标准，95名无放射学改变的脊柱关节病患者），患者自GESPIC研究中选取，均在基线和2年的随访中进行放射学摄片检查。骶髂关节片由中心收集，数字化，随后按修订的纽约标准由2名受过专业训练的读片人进行独立评估分级。读片人对不同时间点的放射片同时评分，但时间点及所有的临床数据对读片人为盲态。 结果： 2年后骶髂关节炎至少有一侧进展一级（2名读片人读片结果一致），nrSpA组为16.8%，AS组为8.7%。同时，骶髂关节炎改善至少一级（2名读片人读片结果一致）nrSpA组为6.3%，AS组为4.3%。这样，2年后准确的放射学骶髂关节炎进展比率为nrSpA组10.5%，AS组4.3%（按观察到的进展和环节比率差异计算）。2年后 nrSpA 组11.6%的患者按修订的纽约标准符合AS诊断。 包括nrSpA和AS组，2年后放射学骶髂关节炎进展至少一级最强的预测因素是基线时CRP水平升高(OR=3.7, p=0.023，OR=5.1, p=0.048, nrSpA和AS组)。重要的，CRP升高水平也是nrSpA患者进展为AS患者的显著预测因素(OR=4.10, p=0.032)。基线时存在明确结果损害（骶髂关节炎单侧2级）也显示与进展为AS相关，但没达到统计学显著性(OR=3.00, p=0.092)。年龄、性别、HLA-B27结果、BASDAI和BASFI评分、有无外周关节炎、附着点炎、葡萄膜炎、SpA家族史、炎症性肠病、使用非甾体抗炎药和抗风湿病药物治疗等因素对放射学骶髂关节炎进展无明确影响。 结论：中轴脊柱关节病患者2年后放射学骶髂关节炎进展至少一级为相对小的比率（nrSpA 组10.5%，AS组4.4% ）。对nrSpA及AS患者的骶髂关节炎进展情况， CRP水平升高均是一个强烈阳性预测因素。 |