2356 The Journal of Rheumatology 2010; 37:11; doi:10.3899/jrheum.100094 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2010. All rights reserved. Determinants of Early Radiographic Progression in Ankylosing Spondylitis PAMIRATAGUNDUZ, SIBELZEHRAAYDIN, CENGIZ BAHADIR, BURAK ERER, and HANER DIRESKENELI ABSTRACT. Objective. To investigate the demographic and clinical characteristics associated with early, exten- sive radiographic changes in ankylosing spondylitis (AS). Methods. Radiographic severity was assessed cross-sectionally in 235 patients with AS using the BathASRadiologicalIndexspinescore(BASRI-s).Patientswithextensiveradiographicchangeson the lumbar portion of BASRI-s were defined as the early axial ankylosis (EAA) Group.ANCOVA and logistic regression analyses were used to identify factors affecting EAA. Results. Most study patients were men (139/235, 59.0%). Mean disease duration was 12.4 ± 9.3 years.Fifteenpercentofwomenand34.8%ofmenwithASwereintheEAAgroup.HLA-B27-pos- itivemenwithAShadsignificantlyhigherBASRI-lumbarscores,whileHLA-B27hadnoeffecton radiographicprogressionofaxialdiseaseinwomenwithAS.Peripheraljointinvolvementwasasso- ciated with slow radiographic progression. Hip involvement had no effect on axial progression but uveitiswasmorefrequentinthemaleEAAgroup.TheoddsforanHLA-B27-positivemalepatient withASwhodidnothaveperipheralarthritisofhavingaBASRI-lumbarscoreof3orhigherwere 3.4 (77% chance to have axially progressive disease). Presence of uveitis increased these odds to 93%.Only15%offemalepatientswithAShadEAA,andtheabsenceofperipheralarthritiswasthe onlyclinicalmeasureassociatedwithEAAinthisgroup. Conclusion. EAAwasmorefrequentinmenwithASthaninwomen.Absenceofperipheralarthri- tis,HLA-B27positivity,anduveitiswereassociatedwithmultiplesyndesmophytesorfusionofmul- tiplevertebraeofthelumbarvertebrae.(FirstReleaseSept152010;JRheumatol2010;37:2356–61; doi:10.3899/jrheum.100094) Key Indexing Terms: ANKYLOSING SPONDYLITIS RADIOGRAPHIC PROGRESSION GENDER SEVERITY From the Department of Rheumatology, Marmara University Faculty of Medicine; Haydarpasa Numune Training and Research Hospital; and Department of Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey. P. Atagunduz, MD, Associate Professor; S.Z. Aydin, MD, Rheumatology Fellow; H. Direskeneli, MD, Professor, Marmara University Faculty of Medicine, Rheumatology; C. Bahadir, MD, Specialist, Haydarpasa Numune Training and Research Hospital; B. Erer, MD, Assistant Professor, Istanbul University Faculty of Medicine, Rheumatology. Address correspondence to P. Atagunduz, Marmara University, School of Medicine, Department of Rheumatology, Tophanelioglu Cad. 13/15, Uskudar, Istanbul, Turkey. E-mail: pamiratagunduz@yahoo.com Accepted for publication July 12, 2010. Ankylosing spondylitis (AS) is a longstanding, chronic inflammatorydiseasewitharelativelyslowrateofprogres- sion. Future restriction of spinal mobility is the major con- cernofpatientswithASatthetimeofdiagnosis;about40% of patients have severe functional loss several decades after the onset 1,2,3,4 . The rate of radiographic progression differs substantially among patients with similar durations of AS 2,5,6 . At present, knowledge about prognostic factors affecting radiographic severity for individual patients is sparse.Previously,peripheralarthritishasbeensuggestedto be a predictor of disease progression 1 and loss of func- tion 7,8 . Similarly, male sex, uveitis, and hip involvement were found to be associated with radiographically progres- sive axial disease 9,10,11,12,13,14 . However, several studies assessing the role of HLA-B27 on radiographic severity reported no association with progression 13,15,16 . PreviousdataonthenaturalcourseofASsuggestthatup to 15% of patients have an accelerated disease course with- inthefirstdecadeafterdiseaseonset.Thisacceleratedfunc- tional loss seems to predict the disease severity in long- standingAS 1 . We therefore aimed to determine the association of demographic and clinical characteristics affecting disease severityinpatientswithASwithshortdiseaseduration.We used the Bath Ankylosing Spondylitis Radiology Index for the spine (BASRI-s) to determine the severity 17 . MATERIALS AND METHODS Patients and data collection. Threehundredsixty-nineconsecutivepatients withASdiagnosedaccordingtothemodifiedNewYorkcriteriaat4differ- ent medical centers in Istanbul, Turkey, were registered between January 2003 and September 2010 for a prospective followup after a final evalua- tionattheMarmaraUniversityHospitalRheumatologyoutpatientclinic 18 . At each medical center, patients completed questionnaires on personal and medicalhistoryandunderwentclinicalevaluationbyanexperiencedphysi- cian.PatientsmeetingthemodifiedNewYorkcriteriawerethenreferredto the rheumatology department of Marmara Medical School. Final enroll- mentinthestudywasdoneby2rheumatologists.Patientswithahistoryor www.jrheum.org Downloaded on January 24, 2022 from