Syndesmophyte Presence Predictive of Further Structural Damage Development in Early Axial Spondyloarthritis

The presence of syndesmophytes can predict the development of further structural damage of the sacroiliac joint in early axial spondyloarthritis (axSpA), according to research results published in Arthritis Care and Research.

Researchers sought to analyze the development and progression of spinal radiographic damage in patients with early axSpA. Patient data were collected from the Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR) cohort, which included patients with a “high suspicion” of recent axSpA. Radiographs of the cervical and lumbar spine were taken at baseline, 2 years, and 5 years, and were scored using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS).

Overall, 549 patients were included in the study (mean age, 34±9 years; mean symptom duration, 1.5±0.9 years; 46% men). A total of 63% of patients fulfilled the Assessment of SpondyloArthritis international Society (ASAS) classification criteria, 13% fulfilled the modified New York (mNYC) criteria, and 7% had ≥1 baseline syndesmophyte. Treatment with tumor necrosis factor inhibitor (TNFi) was nonexistent at baseline; however, by 2 and 5 years, 31% and 43% of patients were treated with a TNFi, respectively.

The mean mSASSS score at baseline was 0.5±1.5 for all patients, while mSASSS for patients who were ASAS- and ASAS+ was 0.6±1.8 and 0.4±1.4, respectively. For all patients, 2- and 5-year mSASSS progression was 0.2±0.9 and 0.4±1.8, with a slightly higher 5-year progression in patients who were ASAS- vs ASAS+ (0.6±2.0 vs 0.3±1.6).

Among patients who underwent magnetic resonance imaging (MRI), investigators noted a gradient beginning with MRI+/mNYC- patients who had a 5-year progression of 0.3±0.8. This group was followed by the MRI-/mNYC+ group and the MRI+/mNYC+ group, which demonstrated the highest progression.

At 5 years, 23% of patients demonstrated mSASSS progression (16% progression >0 and <2 units, 7% progression ≥2); these percentages were higher in patients who fulfilled imaging arm criteria, who were mNYC+ positive, and who had baseline syndesmophytes (26% progression >0; 30%, with 13% progression ≥2; and 74% progression >0 and 39% progression ≥2, respectively).

By 5 years, 91% of patients did not show new syndesmophytes, while 6%, 1%, and 2% had 1, 2, and ≥2 new syndesmophytes, respectively.

Study limitations included a lack of consideration of the influence of other important factors in radiographic progression, including patient characteristics or medication.

“Spinal radiographic progression, although limited in early axial SpA, can be captured after 2 years,” the researchers concluded. “Syndesmophyes, which can already be present early in the axial disease, strongly predispose patients for the development of further structural damage.”  

Disclosure: This study was supported by Pfizer. Please see the original reference for a full list of authors’ disclosures.

Reference

Ramiro S, van der Heijde D, Sepriano A, et al. Spinal radiographic progression in early axial spondyloarthritis: Five-year results from the DESIR Cohort. Arthritis Care Res. 2019;71(12):1678-1684.