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. 2009 Jul 15;61(7):859-66.
doi: 10.1002/art.24585.

Clinical and immunogenetic prognostic factors for radiographic severity in ankylosing spondylitis

Michael M Ward  1 , Matthew R Hendrey, James D Malley, Thomas J Learch, John C Davis Jr, John D Reveille, Michael H Weisman
Affiliations

Clinical and immunogenetic prognostic factors for radiographic severity in ankylosing spondylitis

Michael M Ward et al. Arthritis Rheum. .

Abstract

Objective: To improve prognostic ability in ankylosing spondylitis (AS), we sought to identify demographic, clinical, and immunogenetic characteristics associated with radiographic severity in a large cohort of patients.

Methods: Patients with AS for > or =20 years were enrolled in a cross-sectional study (n = 398). Pelvic and spinal radiographs were scored using the Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s), and radiographic severity was measured as the BASRI-s/duration of AS. Clinical factors and HLA-B, DR, DQ, and DP alleles associated with the highest quartile of the distribution of radiographic severity were identified by first using random forests and then using multivariable logistic regression modeling. Similar procedures were used to identify factors associated with the lowest quartile of radiographic severity.

Results: Radiographic severity (being in the top quartile of BASRI-s/duration of AS) was associated with older age at onset of AS (odds ratio [OR] 1.10 per year), male sex (OR 1.90), current smoker (OR 4.72), and the presence of HLA-B*4100 (OR 11.73), DRB1*0804 (OR 12.32), DQA1*0401 (OR 5.24), DQB1*0603 (OR 3.42), and DPB1*0202 (OR 23.36), whereas the presence of DRB1*0801 was strongly negatively associated (OR 0.03). Being in the lowest quartile of BASRI-s/duration of AS was also less likely among those with an older age at onset of AS (OR 0.94 per year), men (OR 0.28), and current smokers (OR 0.29).

Conclusion: The accuracy of the prognosis of radiographic severity in AS is improved by knowing the age at disease onset, sex, smoking history, and the presence of HLA-B*4100, DRB1*0804, DQA1*0401, DQB1*0603, DRB1*0801, and DPB1*0202 alleles.

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Figures

Figure 1
Figure 1
Rank order of prognostic factors for identifying patients with severe radiographic damage (in the highest quartile of the distribution of BASRI-S/duration), based on 1000 random forest runs, each with 500 trees. Values are the mean rank ± standard error.
Figure 2
Figure 2
Rank order of prognostic factors for identifying patients with less severe radiographic damage (in the lowest quartile of the distribution of BASRI-S/duration), based on 1000 random forest runs, each with 500 trees. Values are mean rank ± standard error.
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