The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Predictive factors of radiographic progression in ankylosing spondylitis

  • Kim, Hyungjin (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jaejoon (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn, Joong Kyong (Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Hwang, Jiwon (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Eun-Jung (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong, Hyemin (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cha, Hoon-Suk (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Koh, Eun-Mi (Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2013.06.27
  • Accepted : 2014.07.23
  • Published : 2015.05.01
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Abstract

Background/Aims: The course of ankylosing spondylitis (AS) is rather variable, and the factors that predict radiographic progression remain largely obscure. In this study, we tried to determine the clinical factors and laboratory measures that are useful in predicting the radiographic progression of patients with AS. Methods: In 64 consecutive patients with AS, we collected radiographic and laboratory data over 3 years. Radiographic data included images of the sacroiliac (SI) and hip joints and laboratory data included areas under the curve (AUC) of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alkaline phosphatase (ALP), and hemoglobin (Hb). We investigated associations among changes in radiographic scores, initial clinical manifestations and laboratory measurements. Results: Changes in scores for the SI joint and lumbar spine did not correlate with AUC for ESR, CRP, or ALP. AUC for Hb did not significantly correlate with radiographic progression in any joint. Patients with hip arthritis at the initial visit showed significantly higher radiographic score changes after 3 years in the SI and hip joint compared to those without hip arthritis. Patients who had shoulder arthritis as the initial manifestation had significantly increased AUCs for ESR and CRP compared to those without shoulder arthritis. However, at 3 years, the change of the lumbar spine score was significantly higher in patients without shoulder arthritis. Conclusions: These results indicate that hip arthritis at presentation is a useful clinical marker for predicting the structural damage to the SI and hip joint, and suggest that initial shoulder arthritis correlates with slower radiographic progression of the lumbar spine.

Keywords

References

  1. Baraliakos X, Listing J, Rudwaleit M, et al. Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Ann Rheum Dis 2007;66:910-915. https://doi.org/10.1136/ard.2006.066415
  2. Brophy S, Mackay K, Al-Saidi A, Taylor G, Calin A. The natural history of ankylosing spondylitis as defined by radiological progression. J Rheumatol 2002;29:1236-1243.
  3. van der Heijde D, Landewe R, van der Linden S. How should treatment effect on spinal radiographic progression in patients with ankylosing spondylitis be measured? Arthritis Rheum 2005;52:1979-1985. https://doi.org/10.1002/art.21133
  4. Ozgocmen S, Godekmerdan A, Ozkurt-Zengin F. Acutephase response, clinical measures and disease activity in ankylosing spondylitis. Joint Bone Spine 2007;74:249-253. https://doi.org/10.1016/j.jbspin.2006.07.005
  5. Ruof J, Stucki G. Validity aspects of erythrocyte sedimentation rate and C-reactive protein in ankylosing spondylitis: a literature review. J Rheumatol 1999;26:966-970.
  6. Sheehan NJ, Slavin BM, Donovan MP, Mount JN, Mathews JA. Lack of correlation between clinical disease activity and erythrocyte sedimentation rate, acute phase proteins or protease inhibitors in ankylosing spondylitis. Br J Rheumatol 1986;25:171-174. https://doi.org/10.1093/rheumatology/25.2.171
  7. Spoorenberg A, van der Heijde D, de Klerk E, et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 1999;26:980-984.
  8. Spoorenberg A, van Tubergen A, Landewe R, et al. Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectives. Rheumatology 2005;44:789-795. https://doi.org/10.1093/rheumatology/keh595
  9. Taylor HG, Wardle T, Beswick EJ, Dawes PT. The relationship of clinical and laboratory measurements to radiological change in ankylosing spondylitis. Br J Rheumatol 1991;30:330-335. https://doi.org/10.1093/rheumatology/30.5.330
  10. Calin A. Ankylosing spondylitis. Clin Rheum Dis 1985;11:41-60.
  11. Morel J, Combe B. How to predict prognosis in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 2005;19:137-146. https://doi.org/10.1016/j.berh.2004.08.008
  12. Zochling J, Braun J, van der Heijde D. Assessments in ankylosing spondylitis. Best Pract Res Clin Rheumatol 2006;20:521-537. https://doi.org/10.1016/j.berh.2006.03.011
  13. Munoz-Villanueva MC, Munoz-Gomariz E, Escudero-Contreras A, Perez-Guijo V, Collantes-Estevez E. Biological and clinical markers of disease activity in ankylosing spondylitis. J Rheumatol 2003;30:2729-2732.
  14. Heuft-Dorenbosch L, van Tubergen A, Spoorenberg A, et al. The influence of peripheral arthritis on disease activity in ankylosing spondylitis patients as measured with the Bath Ankylosing Spondylitis Disease Activity Index. Arthritis Rheum 2004;51:154-159. https://doi.org/10.1002/art.20233
  15. Amor B, Santos RS, Nahal R, Listrat V, Dougados M. Predictive factors for the longterm outcome of spondyloarthropathies. J Rheumatol 1994;21:1883-1887.
  16. Baek HJ, Shin KC, Lee YJ, et al. Clinical features of adult-onset ankylosing spondylitis in Korean patients: patients with peripheral joint disease (PJD) have less severe spinal disease course than those without PJD. Rheumatology 2004;43:1526-1531. https://doi.org/10.1093/rheumatology/keh373
  17. Carette S, Graham D, Little H, Rubenstein J, Rosen P. The natural disease course of ankylosing spondylitis. Arthritis Rheum 1983;26:186-190. https://doi.org/10.1002/art.1780260210
  18. Vander Cruyssen B, Munoz-Gomariz E, Font P, et al. Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology 2010;49:73-81. https://doi.org/10.1093/rheumatology/kep174
  19. Appel H, Kuhne M, Spiekermann S, et al. Immunohistochemical analysis of hip arthritis in ankylosing spondylitis: evaluation of the bone-cartilage interface and subchondral bone marrow. Arthritis Rheum 2006;54:1805-1813. https://doi.org/10.1002/art.21907
  20. Means RT Jr, Krantz SB. Progress in understanding the pathogenesis of the anemia of chronic disease. Blood 1992;80:1639-1647.
  21. Gudbjornsson B, Hallgren R, Wide L, Birgegard G. Response of anaemia in rheumatoid arthritis to treatment with subcutaneous recombinant human erythropoietin. Ann Rheum Dis 1992;51:747-752. https://doi.org/10.1136/ard.51.6.747
  22. Bertero MT, Caligaris-Cappio F. Anemia of chronic disorders in systemic autoimmune diseases. Haematologica 1997;82:375-381.
  23. Marhoffer W, Stracke H, Masoud I, et al. Evidence of impaired cartilage/bone turnover in patients with active ankylosing spondylitis. Ann Rheum Dis 1995;54:556-559. https://doi.org/10.1136/ard.54.7.556
  24. MacDonald AG, Birkinshaw G, Durham B, Bucknall RC, Fraser WD. Biochemical markers of bone turnover in seronegative spondylarthropathy: relationship to disease activity. Br J Rheumatol 1997;36:50-53. https://doi.org/10.1093/rheumatology/36.1.50
  25. Astbury C, Bird HA, McLaren AM, Robins SP. Urinary excretion of pyridinium crosslinks of collagen correlated with joint damage in arthritis. Br J Rheumatol 1994;33:11-15.
  26. Lories RJ, Derese I, de Bari C, Luyten FP. Evidence for uncoupling of inflammation and joint remodeling in a mouse model of spondylarthritis. Arthritis Rheum 2007;56:489-497. https://doi.org/10.1002/art.22372
  27. Davis JC Jr, Van Der Heijde D, Braun J, et al. Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Arthritis Rheum 2003;48:3230-3236. https://doi.org/10.1002/art.11325
  28. van der Heijde D, Dijkmans B, Geusens P, et al. Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthritis Rheum 2005;52:582-591. https://doi.org/10.1002/art.20852
  29. Wanders AJ, Landewe RB, Spoorenberg A, et al. What is the most appropriate radiologic scoring method for ankylosing spondylitis? A comparison of the available methods based on the Outcome Measures in Rheumatology Clinical Trials filter. Arthritis Rheum 2004;50:2622-2632. https://doi.org/10.1002/art.20446
  30. 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;64:127-129. https://doi.org/10.1136/ard.2004.020503

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