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
. 2019 May 24;21(1):126.
doi: 10.1186/s13075-019-1913-z.

Incorporation of the anteroposterior lumbar radiographs in the modified Stoke Ankylosing Spondylitis Spine Score improves detection of radiographic spinal progression in axial spondyloarthritis

Maria Llop  1   2 , Valeria Rios Rodriguez  1 , Imke Redeker  1   3 , Joachim Sieper  1 , Hildrun Haibel  1 , Martin Rudwaleit  1   4 , Denis Poddubnyy  5   6
Affiliations

Incorporation of the anteroposterior lumbar radiographs in the modified Stoke Ankylosing Spondylitis Spine Score improves detection of radiographic spinal progression in axial spondyloarthritis

Maria Llop et al. Arthritis Res Ther. .

Abstract

Background: To evaluate the performance of the extended modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) incorporating information from anteroposterior (AP) lumbar radiographs as compared to the conventional mSASSS in detection of radiographic spinal progression in patients with axial spondyloarthritis (axSpA) METHODS: A total of 210 patients with axSpA, 115 with radiographic axSpA (r-axSpA), and 95 with non-radiographic axSpA (nr-axSpA), from the GErman SPondyloarthritis Inception Cohort (GESPIC), were included in the analysis based on the availability of spinal radiographs (cervical spine lateral, lumbar spine lateral, and AP views), at baseline and year 2. Two trained readers independently scored lateral cervical and lumbar spine images according to the mSASSS system (0-3 per vertebral corner, 0-72 in total). In addition, all vertebral corners of vertebral bodies visible on lumbar AP radiographs (lower T12 to upper S1) were assessed according to the same scoring system that resulted in a total range for the extended mSASSS from 0 to 144. Reliability and sensitivity to detect radiographic spinal progression of the extended mSASSS as compared to the conventional mSASSS were evaluated.

Results: The reliability of conventional and extended scores was excellent with intraclass correlation coefficients (ICCs) of 0.926 and 0.927 at baseline and 0.920 and 0.933 at year 2, respectively. The mean ± SD score for mSASSS and extended mSASSS at baseline were 4.25 ± 8.32 and 8.59 ± 17.96, respectively. The change score between baseline and year 2 was 0.73 ± 2.34 and 1.19 ± 3.73 for mSASSS and extended mSASSS, respectively. With the extended mSASSS, new syndesmophytes after 2 years were detected in 4 additional patients, new syndesmophytes or growth of existing syndesmophytes in 5 additional patients, and progression by ≥ 2 points in the total score in 14 additional patients meaning a 25%, 28%, and 46% increase in the proportion of patients with progression according to the respective definition as compared to the conventional score.

Conclusions: Incorporation of lumbar AP radiographs in the assessment of structural damage in the spine resulted into detection of additional patients with radiographic spinal progression not captured by the conventional mSASSS score.

Keywords: Axial spondyloarthritis; Radiographic spinal progression; Radiographs; X-rays; mSASSS.

PubMed Disclaimer

Conflict of interest statement

ML: none declared

VRR: consulting fees, speaking fees, and/or honoraria from AbbVie, MSD, and Novartis

IR: none declared

JS: consulting fees, speaking fees, and/or honoraria from AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

HH: consulting fees, speaking fees, and/or honoraria from AbbVie, Janssen, MSD, and Novartis

MR: consulting fees, speaking fees, and/or honoraria AbbVie, BMS, Celgene, Chugai, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB

DP: consulting fees, speaking fees, and/or honoraria from AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB

Figures

Fig. 1
Fig. 1
Bland and Altman plots for mSASSS (a) and extended mSASSS (b)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361–368. doi: 10.1002/art.1780270401. - DOI - PubMed
    1. Machado P, Landewe R, Braun J, Hermann KG, Baker D, van der Heijde D. Both structural damage and inflammation of the spine contribute to impairment of spinal mobility in patients with ankylosing spondylitis. Ann Rheum Dis. 2010;69(8):1465–1470. doi: 10.1136/ard.2009.124206. - DOI - PubMed
    1. Landewe R, Dougados M, Mielants H, van der Tempel H, van der Heijde D. Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Ann Rheum Dis. 2009;68(6):863–867. doi: 10.1136/ard.2008.091793. - DOI - PubMed
    1. Poddubnyy D, Listing J, Haibel H, Knuppel S, Rudwaleit M, Sieper J. Functional relevance of radiographic spinal progression in axial spondyloarthritis: results from the GErman SPondyloarthritis Inception Cohort. Rheumatology (Oxford) 2018;57(4):703–711. doi: 10.1093/rheumatology/kex475. - DOI - PubMed
    1. Creemers MC, Franssen MJ, van't Hof MA, Gribnau FW, van de Putte LB, van Riel PL. Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis. 2005;64(1):127–129. doi: 10.1136/ard.2004.020503. - DOI - PMC - PubMed

Publication types