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[665] - Rates and Predictors of Radiographic Sacroiliitis
Progression over Two Years in Patients with Axial
Spondyloarthritis.
Denis
Poddubnyy1,Martin Rudwaleit2,Hildrun
Haibel2,Anja Weiss3,Elisabeth
Märker-Hermann4,Henning Zeidler5,Jürgen
Braun6,Joachim Sieper7. 1Charité -
Campus Benjamin Franklin, Berlin, Germany,
Berlin,2Charité - Campus Benjamin Franklin, Berlin,
Germany,3Deutsches Rheumaforschungszentrum, Berlin,
Germany,4Dr. Horst Schmidt Kliniken, Wiesbaden,
Germany,5Medizinische Hochschule, Hannover,
Germany,6Rheumazentrum Ruhrgebiet, Herne,
Germany,7Dept of Medicine/Rheumatology, Charite Campus
Benjamin Frankl, Berlin
Background: The current concept of axial spondyloarthritis
(SpA) considers non-radiographic axial SpA and ankylosing
spondylitis (AS) as two stages of one diseases suggesting
progression of radiographic sacroiliitis over time. However, rates
of radiographic sacroiliitis progression and predictors of such
progression remain unclear until now. The objective of the study
was to assess the rates of radiographic sacroiliitis progression
and to explore possible progression predictors in a cohort of
patients with axial SpA over a period of two years.
Methods: 210 patients with axial SpA (AS and
non-radiographic axial SpA) from the German Spondyloarthritis
Inception Cohort (GESPIC) have been selected for this analysis
based on availability of radiographs at baseline and after 2 years
of follow-up. Radiographs of pelvis at baseline were centrally
digitized and the sacroiliac joints were scored independently
according to the grading system of the modified New York criteria
by 2 trained readers. The readers scored both time points
simultaneously but were blinded for the time point and for all
clinical data.
Results: In total, 115 patients (54.8%) fulfilled the
modified New York criteria for AS in their radiographic part in
opinion of both readers at baseline, while 95 patients (45.2%) were
classified as non-radiographic axial SpA (nrSpA). After 2 years 11
patients (11.6%) from the group of nrSpA fulfilled the modified New
York criteria for AS in the opinion of both readers.
Progression of sacroiliitis over two years by at least one grade at
one side in opinion of both readers was found in 26 patients
(12.4%). Rate of progression was higher among patients with nrSpA
(16 patients or 16.8%) as compared to AS (10 patients or 8.7%),
although the difference was statistically non-significant
(p=0.074). At the same time, there was an improvement of
sacroiliitis by at least one grade in the opinion of both readers
in 11 patients (5.2%): 6 with nrSpA (6.3%) and 5 with AS (4.3%).
Therefore the true radiographic sacroiliitis progression rate over
two years could be estimated as 10.5% for patients with nrSpA and
4.4% for patients with AS.
The only one strong positive predictor of radiographic sacroiliitis
progression was an elevated level of C-reactive protein at baseline
(OR 2.61, p=0.026) - table. Interestingly, presence of definite
sacroiliitis at baseline was rather negative predictor of
radiographic progression (OR 0.42, p=0.038), which is also
illustrated by a higher rate of progression in the group of
patients with nrSpA.
Table. Odds ratios (ORs) for progression of radiographic
sacroiliitis by at least one grade over 2 years in patients with
axial SpA (univariate analysis).
Conclusion: Progression of radiographic
sacroiliitis by one grade after 2 years occurred in 10.5% of the
patients with nrSpA and 4.4% of the patients with AS. Elevated
level of CRP was found to be a strong positive predictor of
sacroiliitis progression.
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中轴型SpA骶髂关节炎2年间放射学进展的发生率与预测因素
Poddubnyy D, et al. ACR 2010. Present No:
665.
背景：目前关于中轴型SpA的观点认为无放射学改变的中轴型脊柱关节炎(SpA)与强直性脊柱炎(AS)是一种疾病的两个阶段，提示骶髂关节炎的放射学改变随时间而进展。然而，这种进展的发生率与预测因素尚不明确。本研究旨在研究中轴型SpA患者骶髂关节炎2年间放射学进展的发生率与可能的预测因素。
方法：从德国脊柱关节炎起始队列（GESPIC）研究中选取210例中轴型SpA患者（AS和无放射学改变的中轴型SpA[nrSpA]），评估其基线期和2年后的放射学变化。采用纽约修订标准中的分级系统，由2名阅片者分别独立进行骶髂关节放射学盲态评分。
结果：2名阅片者一致认为，共有115例患者（54.8%）的放射学改变在基线期符合纽约修订版AS分类标准，另外95例患者（45.2%）归类为无放射学改变的中轴型SpA（nrSpA）。2年后，11例nrSpA组患者达到纽约修订版AS分类标准。
26例患者（12.4%）的单侧骶髂关节炎2年间进展≥1个等级。nrSpA患者（16例，16.8%）的进展率高于AS（10例，8.7%），但差异无统计学意义（p=0.074）。另外，11例患者（5.2%）的单侧骶髂关节炎2年间改善≥1个等级: 6例nrSpA（6.3%），5例AS（4.3%）。nrSpA患者骶髂关节炎2年间放射学进展的确切发生率为10.5%，AS患者为4.4%。
骶髂关节炎放射学进展的阳性预测因素为基线期CRP升高（OR 2.61, p=0.026）。有趣的是，基线期存在骶髂关节炎倒是放射学进展的阴性预测因素（OR 0.42, p=0.038），nrSpA患者组的放射学进展率更高似乎也支持了这一点。
表
中轴型SpA患者骶髂关节炎2年间放射学进展至少1个等级的比值比（单变量分析）
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基线参数
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OR
(95%CI)
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P
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性别,
男vs女
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0.47
(0.26-1.1)
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0.080
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HLA-B27,阳性vs阴性
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0.85
(0.32-2.3)
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0.736
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CRP, >6mg/L vs
≤6mg/L
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2.61
(1.12-6.06)
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0.026
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ESR, >20mm/h vs
≤20mm/h
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1.28
(0.54-3.06
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0.575
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BASDAI, >4 vs
≤4
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1.00
(0.44-2.28)
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0.997
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病程, >5年vs≤5年
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1.29
(0.55-3.02)
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0.554
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基线有明确的骶髂关节炎*
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0.42
(0.18-0.95)
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0.038
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*:
两位读片师同时判定单侧骶髂关节存在至少2级及以上变化; OR:
比值比; CI:
置信区间; CRP: C反应蛋白; ESR:
血沉; NRS:
数字化评级尺
结论：nrSpA患者骶髂关节炎2年间放射学进展一个等级的发生率为10.5%，AS患者为4.4%。CRP升高是骶髂关节炎进展的阳性预测因素。
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