J Korean Rheum Assoc.  2010 Dec;17(4):376-385. 10.4078/jkra.2010.17.4.376.

Determining Clinical Risk Factors for Radiographical Severity in Patients with Ankylosing Spondylitis in Daegu and Kyungpook Territories

• Jung HY
• Lee HJ
• Choe JY
• Park SH
• Kim SK
• Kim SH
• Kim J
• Han SW
• Kim SH

• KMID: 2201895
• DOI: http://doi.org/10.4078/jkra.2010.17.4.376

Abstract

OBJECTIVE
This study was designed to identify prognostic determinants of radiographical severity in patients with ankylosing spondylitis (AS) living in Daegu and Kyungpook territories.
METHODS
One hundred-nineteen patients with AS were consecutively enrolled from four regional general hospitals. Clinical data including smoking habits, alcohol intake, disease duration, HLA-B27 positivity, involvement of peripheral joints, occupational activity, and regular exercise were investigated. Radiographical severity was assessed by the Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Statistical analyses were performed using the independent Student's t-test, Pearson's correlation coefficient analysis, and multivariate regression analysis.
RESULTS
Radiographical severity, as evaluated with the mSASSS, was associated with age of disease onset (p=0.011) and disease duration (p<0.001). Additionally, mSASSS was significantly higher in males than females (p=0.039) and in patients without involvement of ankle arthritis than those with involvement of ankle arthritis (p=0.026). Patients with hip arthritis had significantly higher mSASSS scores than those without hip arthritis. A multivariate regression analysis showed that older age of disease onset, male gender, and disease duration were independent predictors of AS radiographical severity (p<0.001, p=0.013, and p<0.001, respectively). Hip arthritis was an independent predictor of C-spine radiographical severity in AS (p=0.031).
CONCLUSION
Radiographical severity of the prognosis was determined by age of disease onset, gender, and disease duration in patients with AS living in Daegu and Kyungpook territories.

Keyword

Ankylosing spondylitis; Age; Gender; Peripheral arthritis; mSASSS

MeSH Terms

Animals
Ankle
Arthritis
Female
Hip
HLA-B27 Antigen
Hospitals, General
Humans
Joints
Male
Prognosis
Risk Factors
Smoke
Smoking
Spondylitis, Ankylosing
HLA-B27 Antigen
Smoke

Figure

• 

  Fig. 1. Association of the Modified Stoke Ankylosing Spondylitis Spinal Score as a radiographical severity index with age of disease onset and disease duration. (A) An older age at onset in patients with ankylosing spondylitis was associated with more advanced radiological damages (R=0.233, p=0.011). (B) More advanced radiographical progression was closely associated with disease duration (R=0.382, p<0.001).

Reference

1). Gabriel SE., Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther. 2009. 11:229.

2). Dagfinrud H., Mengshoel AM., Hagen KB., Loge JH., Kvien TK. Health status of patients with ankylosing spondylitis: a comparison with the general population. Ann Rheum Dis. 2004. 63:1605–10.

3). Mackay K., Brophy S., Mack C., Doran M., Calin A. The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the Bath Ankylosing Spondylitis Radiology Hip index. J Rheumatol. 2000. 27:2866–72.

4). 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. 64:127–9.

5). Wanders A., Landerwe R., Spoorenbeg A., de Vlam K., Mielants H., Dougados M, et al. Scoring of radiographic progression in randomised clinical trials in ankylosing spondylitis: a preference for paired reading order. Ann Rheum Dis. 2004. 63:1601–4.

6). Salaffi F., Carotti M., Garofalo G., Giuseppetti GM., Grassi W. Radiological scoring methods for ankylosing spondylitis: a comparison between the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score. Clin Exp Rheumatol. 2007. 25:67–74.

7). Chandran V., O'Shea FD., Schentag CT., Inman RD., Gladman DD. Relationship between spinal mobility and radiographic damage in ankylosing spondylitis and psoriatic spondylitis: a comparative analysis. J Rheumatol. 2007. 34:2463–5.

8). 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. 29:1236–43.

9). Doran MF., Brophy S., Mackay K., Taylor G., Calin A. Predictors of longterm outcome in ankylosing spondylitis. J Rheumatol. 2003. 30:316–20.

10). Ward MM., Hendrey MR., Malley JD., Learch TJ., Davis JC Jr., Reveille JD, et al. Clinical and immunogenetic prognostic factors for radiographic severity in ankylosing spondylitis. Arthritis Rheum. 2009. 61:859–66.

11). Lee W., Reveile JD., Davis JC Jr., Learch TJ., Ward MM., Weisman MH. Are there gender differences in severity of ankylosing spondylitis? Results from the PSOAS cohort. Ann Rheum Dis. 2007. 66:633–8.

12). Lee HS., Kim TH., Yun HR., Park YW., Jung SS., Bae SC, et al. Radiologic changes of cervical spine in ankylosing spondylitis. Clin Rheumatol. 2001. 20:262–6.

13). Jung YO., Kim I., Kim S., Suh CH., Park HJ., Park W, et al. Clinical and radiographic features of adult-onset ankylosing spondylitis in Korean patients: comparisons between males and females. J Korean Med Sci. 2010. 25:532–5.

14). Baek HJ., Shin KC., Lee YJ., Kang SW., Lee EB., Yoo CD, 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 (Oxford). 2004. 43:1526–31.

15). Baek HJ., Shin KC., Lee YJ., Kang SW., Lee EB., Yoo CD, et al. Juvenile onset ankylosing spondylitis (JAS) has less severe spinal disease course than adult onset ankylosing spondylitis (AAS): clinical comparison between JAS and AAS in Korea. J Rheumatol. 2002. 29:1780–5.

16). van der Linden S., Valkenburg HA., Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis; a proposal for modification of the modified New York criteria. Arthritis Rheum. 1984. 27:361–8.

17). Kim H., Kim S., Jee SH. The independent effects of cigarette smoking, alcohol consumption, and serum aspartate aminotransferase on the alanine aminotransferase ratio in Korean men for the risk for esophageal cancer. Yonsei Med J. 2010. 51:310–7.

18). Gensler LS., Ward MM., Reveille JD., Learch TJ., Weisman MH., Davis JC Jr. Clinical, radiographic and functional differences between juvenile-onset and adult-onset ankylosing spondylitis: results from the PSOAS cohort. Ann Rheum Dis. 2008. 67:233–7.

19). Kim TJ., Na KS., Lee HJ., Lee B., Kim TH. HLA-B27 homozygosity has no influence on clinical manifestations and functional disability in ankylosing spondylitis. Clin Exp Rheumatol. 2009. 27:574–9.

20). 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. 68:863–7.

21). Sampaio-Barros PD., Bertolo MB., Kraemer MH., Neto JF., Samara AM. Primary ankylosing spondylitis: patterns of disease in a Brazilian population of 147 patients. J Rheumatol. 2001. 28:560–5.

22). Brophy S., Calin A. Ankylosing spondylitis: interaction between genes, joints, age at onset, and disease expression. J Rheumatol. 2001. 28:2283–8.

23). Calin A., Mackay K., Santos H., Brophy S. A new dimension to outcome: application of the Bath Ankylosing Spondylitis Radiology Index. J Rheumatol. 1999. 26:988–93.

24). Amor B., Santos R., Nahal R., Listrat V., Dougados M. Predictive factors for the long-term outcome of spondyloarthropathies. J Rheumatol. 1994. 21:1883–7.

25). Boonen A., vander Cruyssen B., de Vlam K., Steinfeld S., Ribbens C., Lenaerts J, et al. Spinal radiographic changes in ankylosing spondylitis: association with clinical characteristics and functional outcome. J Rheumatol. 2009. 36:1249–55.

26). Smith JA., Marker-Hermann E., Colbert RA. Patholgenesis of ankylosing spondylitis: current concepts. Best Pract Res Clin Rheumatol. 2006. 20:571–91.

27). Calin A., Fries JF., Schuman D., Payne R. The close correlation between symptoms and disease expression in HLA B27 positive individuals. J Rheumatol. 1977. 4:277–81.

28). Russell AS., Lentile BC., Schlaut J. Radiologic and scintiscan findings in HLA-B27 negative patients with ankylosing spondylitis. J Rheumatol. 1976. 3:321–3.

29). Averns H., Oxtoby J., Taylor H., Jones P., Dziedzic K., Dawes P. Smoking and outcome in ankylosing spondylitis. Scand J Rheumatol. 1996. 25:138–42.

30). Baraliakos X., Davis J., Tsuji W., Braun J. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis before and after therapy with the tumor necrosis factor alpha receptor fusion protein etanercept. Arthritis Rheum. 2005. 52:1216–23.

31). Lambert RG., Salonen D., Rahman P., Inman RD., Wong RL., Einstein SG, et al. Adalimumab significantly reduces both spinal and sacroiliac joint inflammation in patients with ankylosing spondylitis: a multicenter, randomized, double-blind, placebo-controlled study. Arthritis Rheum. 2007. 56:4005–14.