Baseline radiographic damage, elevated acute phase reactants and cigarette smoking status predict radiographic progression in the spine in early axial spondyloarthritis

Arthritis & Rheumatism, 04/19/2012

Poddubnyy D et al. – The presence of radiographic damage at baseline (syndesmophytes), elevated acute phase reactants, and cigarette smoking were all independently associated with radiographic spinal progression in early axial spondyloarthritis (SpA).


  • Two hundred and ten patients with axial SpA from the German Spondyloarthritis Inception Cohort (GESPIC) were selected for this analysis based on availability of radiographs at baseline and after two years of follow–up.
  • Spinal radiographs were scored by two trained readers in a concealed, randomly selected order according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) scoring system.
  • Radiographic spinal progression was defined as a worsening of the mean mSASSS score by =2 units over two years.


  • Altogether, 14.3% of the patients with axial SpA (20% with AS and 7.4% with nonradiographic axial SpA) showed spinal radiographic progression after 2 years.
  • The following parameters were independently associated with radiographic spinal progression: presence of syndesmophytes at baseline (odds ratio (OR)=6.29, p<0.001), elevated markers of systemic inflammation (erythrocyte sedimentation rate: OR=4.04, p=0.001, C–reactive protein: OR=3.81, p=0.001), and cigarette smoking (OR=2.75, p=0.012), that was confirmed in the multivariate logistic regression analysis.
  • No clear association with radiographic spinal progression was found for HLA–B27 status, sex, age, disease duration, BASDAI, BASFI, presence of peripheral arthritis, enthesitis, psoriasis, treatment with NSAIDs or with DMARDs at baseline.

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