Disease activity is associated with radiographic spinal progression in early axial spondyloarthritis.
INTRODUCTION
Ankylosing spondylitis is a chronic inflammatory disease. It mainly involves the spine, but may be associated with other diseases, such as psoriasis (a skin disease), inflammatory bowel disease and uveitis (an inflammation in the eye). These non-joint symptoms are known as extra-articular manifestations and they may arise from the same underlying causes, typically inflammation in the body. Patients can also be classified as having axial or non-axial (peripheral) disease, according to which joints in their body are affected. Axial disease affects the sacroiliac joint (in the back part of the pelvis) and the spine, causing back pain and stiffness.
As the disease goes on, the joints can become damaged, a process referred to as radiographic or structural progression because the damage can be seen on a radiograph (X-ray). This damage has an important bearing on how well people can move, and can affect their life and well-being in many ways.
WHAT DID THE AUTHORS HOPE TO FIND?
The authors wanted to see whether there is a relationship between disease activity and the development of new bone (structural damage) in the spine in people with early forms of axial spondyloarthritis. A similar association has been shown in people who have had the disease for longer (more advanced disease).
WHO WAS STUDIED?
The study looked at 178 people with early axial spondyloarthritis. This means that they had shown symptoms for less than 10 years, or less than 5 years in the case of some forms of the disease. The average age was 38 years, and there were equal numbers of men and women.
HOW WAS THE STUDY CONDUCTED?
This was part of an observational study called GESPIC. This means that the people in the study had no specific medical intervention being tested, but simply had information about their medical history and lifestyle collected in a database, which allowed the researchers to investigate certain links or risks.
The study took place over 2 years. During this time, everyone had a clinical examination every 6 months, and a spinal X-ray at the start and end of the study. Disease activity was decided based on a measure called the Ankylosing Spondylitis Disease Activity Index (ASDAS). This is a way of scoring a person’s disease activity based on different factors, including pain, stiffness, and the level of inflammation shown by a marker called C-reactive protein (or CRP) in the blood.
WHAT WERE THE MAIN FINDINGS?
The authors found that people with higher disease activity had more structural damage in their spine after 2 years. This was not affected by the different treatments people were taking or other lifestyle factors such as smoking. There was a particularly strong link between having high levels of inflammation at the start of the study and going on to develop spinal damage.
ARE THESE FINDINGS NEW?
Yes, this is the first time that structural damage has been linked to disease activity in people with early forms of axial spondyloarthritis.
ARE THERE ANY LIMITATIONS?
This was an observational trial, so there are some limitations to the conclusions that can be drawn. It is not known whether lowering the inflammation might have reduced the risk of structural damage. Also, quite a lot of patients did not complete the study, which may affect how reliable the results are.
WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
More studies are needed in order to confirm the revealed association.
WHAT DOES THIS MEAN FOR ME?
This study shows that disease activity is strongly linked to radiographic spinal progression. If you have axial spondyloarthritis, early anti-inflammatory treatment may help to limit the damage and preserve your mobility.
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Date prepared: December 2016
Summary based on research article published on: 28 April 2016
From: Poddubnyy, D. et al. High disease activity according to the Ankylosing Spondylitis Disease Activity Score is associated with accelerated radiographic spinal progression in patients with early axial spondyloarthritis: results from the GErman SPondyloarthritis Inception Cohort. Ann Rheum Dis 2016;75:2114–8. doi: 10.1136/
annrheumdis-2016-209209.
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