OP0075 SPINAL RADIOGRAPHIC PROGRESSION IN AXIAL SPONDYLOARTHRITIS AND THE IMPACT OF CLASSIFICATION AS NONRADIOGRAPHIC VERSUS RADIOGRAPHIC DISEASE
Authors: M. Hebeisen, R. Micheroli, A. Scherer, X. Baraliakos, M. De Hooge, D. Van der Heijde, R. B. M. Landewé, K. Buerki, M. Nissen, B. Moeller, P. Zufferey, P. Exer, A. Ciurea
Journal: Annals of the Rheumatic Diseases (2020)

Background: Data on spinal radiographic progression is more limited in nonradiographic axial spondyloarthritis (nr-axSpA) than in the radiographic disease state (r-axSpA). It remains unclear, whether radiographic sacroiliitis is by itself associated with progression of spinal structural damage. Objectives: To investigate whether spinal radiographic progression relates to structural damage at the sacroiliac level in axSpA by means of statistical mediation analyses in a large prospective real-life cohort of patients with axSpA. Methods: Patients from the Swiss Clinical Quality Management cohort were included if they fulfilled the ASAS classification criteria and could be classified as nr-axSpA or r-axSpA after central scoring of pelvis radiographs. Spinal radiographs performed every 2 years were scored according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). The relationship between classification status and spinal progression over 2 years was investigated using binomial generalized estimating equations models with adjustment for sex, ankylosing spondylitis disease activity score (ASDAS) and tumor necrosis factor inhibitor treatment. Baseline spinal damage was considered an intermediate variable and included in sensitivity analyses, as were additional variables potentially influencing radiographic progression. Results: In total, 88 nr-axSpA and 418 r-axSpA patients contributed to data for 725 radiographic intervals (Table 1). Mean (SD) mSASSS change over 2 years was 0.16 (0.62) units in nr-axSpA and 0.92 (2.78) units in r-axSpA, p=0.01. Nr-axSpA was associated with a significantly lower progression over 2 years (defined as an increase in ≥2 mSASSS units) in adjusted analyses (OR 0.33, 95%CI 0.13; 0.83), confirmed with progression defined as the formation of ≥1 syndesmophyte. Mediation analyses revealed that sacroiliitis exerted its effect on spinal progression indirectly by being associated with the appearance of a first syndesmophyte (OR 0.09, 95%CI 0.02; 0.36 for nr-axSpA vs r-axSpA) (Fig. 1 and 2). Baseline syndesmophytes were predictors of further progression. Table 1. Baseline characteristics at first radiograph. Parameter N 506 nr-axSpA N = 88 r-axSpA N = 418 P Female sex, % 506 54.5 33.7 &lt;0.001 Age, y 506 39.5±11.1 40.4±11.0 0.52 Symptom duration, y 498 10.0±9.9 14.0±9.8 &lt;0.001 HLA-B27 positive, % 452 71.6 80.7 0.09 BASDAI 427 4.6±2.0 4.2±2.3 0.26 ASDAS 408 2.8±0.9 2.8±1.1 0.74 Elevated CRP, % 422 30.6 40.6 0.14 BASFI 433 2.8±2.2 3.1±2.5 0.71 BASMI 435 1.1±1.4 2.2±2.0 &lt;0.001 mSASSS 506 0.9±1.5 6.8±12.7 &lt;0.001 Syndesmophytes, % 506 9.1 35.2 &lt;0.001 On TNFi, % 506 19.3 36.4 0.002 Fig. 1. Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) for individual patients plotted as a function of duration since symptom onset. Fig. 2. Two-year mSASSS progression depicted in a cumulative probability plot. Progression was defined as an increase in mSASSS of at least 2 units (dotted line) in 2 years. Conclusion: Spinal structural damage is mainly restricted to patients with r-axSpA, leading to relevant prognostic and therapeutic implications. Disclosure of Interests: Monika Hebeisen: None declared, Raphael Micheroli: None declared, Almut Scherer: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Manouk de Hooge: None declared, Désirée van der Heijde Consultant of: AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead Sciences, Inc., Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma; Director of Imaging Rheumatology BV, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly &amp; Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Kristina Buerki: None declared, Michael Nissen Grant/research support from: Abbvie, Consultant of: Novartis, Lilly, Abbvie, Celgene and Pfizer, Speakers bureau: Novartis, Lilly, Abbvie, Celgene and Pfizer, Burkhard Moeller: None declared, Pascal Zufferey: None declared, Pascale Exer: None declared, Adrian Ciurea Consultant of: Consulting and/or speaking fees from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Merck Sharp &amp; Dohme, Novartis and Pfizer.