Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Apr 16;10(4):e0122693.
doi: 10.1371/journal.pone.0122693. eCollection 2015.

Spinal radiographic progression in patients with ankylosing spondylitis treated with TNF-α blocking therapy: a prospective longitudinal observational cohort study

Fiona Maas  1 , Anneke Spoorenberg  2 , Elisabeth Brouwer  1 , Reinhard Bos  3 , Monique Efde  3 , Rizwana N Chaudhry  1 , Nic J G M Veeger  4 , Peter M A van Ooijen  5 , Rinze Wolf  6 , Hendrika Bootsma  1 , Eveline van der Veer  7 , Suzanne Arends  2
Affiliations

Spinal radiographic progression in patients with ankylosing spondylitis treated with TNF-α blocking therapy: a prospective longitudinal observational cohort study

Fiona Maas et al. PLoS One. .

Abstract

Objectives: To evaluate spinal radiographic damage over time and to explore the associations of radiographic progression with patient characteristics and clinical assessments including disease activity in ankylosing spondylitis (AS) patients treated with tumor necrosis factor-alpha (TNF-α) blocking therapy in daily clinical practice.

Methods: Consecutive outpatients from the Groningen Leeuwarden AS (GLAS) cohort were included based on the availability of cervical and lumbar radiographs before start of TNF-α blocking therapy and after 2, 4, and/or 6 years of follow-up. Clinical data were assessed at the same time points. Radiographs were scored by two independent readers using the modified Stoke AS Spine Score (mSASSS). Spinal radiographic progression in relation to clinical assessments was analyzed using generalized estimating equations.

Results: 176 AS patients were included, 58% had syndesmophytes at baseline. Median mSASSS increased significantly from 10.7 (IQR: 4.6-24.0) at baseline to 14.8 (IQR: 7.9-32.8) at 6 years. At the group level, spinal radiographic progression was linear with a mean progression rate of 1.3 mSASSS units per 2 years. Both spinal radiographic damage at baseline and radiographic progression were highly variable between AS patients. Male gender, older age, longer disease duration, higher BMI, longer smoking duration, high CRP, and high ASDAS were significantly associated with syndesmophytes at baseline. Significantly more radiographic progression was seen in patients with versus without syndesmophytes (2.0 vs. 0.5 mSASSS units per 2 years) and in patients >40 versus ≤40 years of age (1.8 vs. 0.7 mSASSS units per 2 years). No longitudinal associations between radiographic progression and clinical assessments were found.

Conclusions: This prospective longitudinal observational cohort study in daily clinical practice shows overall slow and linear spinal radiographic progression in AS patients treated with TNF-α blocking therapy. At the individual level, progression was highly variable. Patients with syndesmophytes at baseline showed a 4-fold higher radiographic progression rate than patients without syndesmophytes.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: Anneke Spoorenberg has received research grants from Abbott, Pfizer, and Wyeth and consulting fees from Abbvie, Pfizer, and UCB. Elisabeth Brouwer and Suzanne Arends have received research grants from Abbott, Pfizer, and Wyeth. Reinhard Bos has received research grants and consulting fees from Pfizer. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. The other authors have declared that they have no competing interests.

Figures

Fig 1
Fig 1. Flowchart of AS patients included in the analysis.
Fig 2
Fig 2. Spinal radiographic progression at patient level of AS patients with 6 years of follow-up (n = 50).
See this image and copyright information in PMC

References

    1. Braun J, Sieper J. Ankylosing spondylitis. Lancet. 2007;369: 1379–1390. - PubMed
    1. Baraliakos X, Listing J, Rudwaleit M, Brandt J, Sieper J, Braun J. Radiographic progression in patients with ankylosing spondylitis after 2 years of treatment with the tumour necrosis factor alpha antibody infliximab. Ann Rheum Dis. 2005;64: 1462–1466. - PMC - PubMed
    1. van der Heijde D, Landewe R, Baraliakos X, Houben H, van Tubergen A, Williamson P, et al. Radiographic findings following two years of infliximab therapy in patients with ankylosing spondylitis. Arthritis Rheum. 2008;58: 3063–3070. 10.1002/art.23901 - DOI - PubMed
    1. van der Heijde D, Landewe R, Einstein S, Ory P, Vosse D, Ni L, et al. Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept. Arthritis Rheum. 2008;58: 1324–1331. 10.1002/art.23471 - DOI - PubMed
    1. van der Heijde D, Salonen D, Weissman BN, Landewé R, Maksymowych WP, Kupper H, et al. Assessment of radiographic progression in the spines of patients with ankylosing spondylitis treated with adalimumab for up to 2 years. Arthritis Res Ther. 2009;11: R127 10.1186/ar2794 - DOI - PMC - PubMed

Publication types

Substances