Prevalence of Vertebral Fractures by Semiautomated Morphometry in Patients with Ankylosing Spondylitis

Objective.Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the axial skeleton and characterized by ossification of the spinal disc, joints, and ligaments leading to progressive ankylosis. Vertebral osteoporosis is a recognized feature of AS. Studies have confirmed a moderate to high prevalence of vertebral fractures with extremely varying ranges in patients with AS. Our objective was to estimate the prevalence of vertebral fractures in a representative Spanish population of patients with AS using a validated semiquantitative method, MorphoXpress®.Methods.Patients were randomly selected from the 10 initial participating centers of the Spanish National Registry of Spondyloarthropathies (REGISPONSER) by consecutive sampling. All patients fulfilled the New York modified criteria for AS and had a baseline thoracolumbar radiograph. A prevalent vertebral fracture was defined according to the Genant classification criteria.Results.The estimated prevalence of vertebral fractures was 32.4% (95% CI 25.5%–39.3%). The majority of fractures were localized in the thoracic segment (n = 100; 82.%) and were mild (n = 79; 64.8%). In logistic regression analysis, age (odds ratio per year 1.05, 95% CI 1.03–1.08, p < 0.001), disease duration (OR per year 1.03, 95% CI 1.01–1.06, p = 0.011), Bath Ankylosing Spondylitis Functional Index score (OR per score 1.16, 95% CI 1.03–1.30, p = 0.015), Bath Ankylosing Spondylitis Radiographic Index-TS (OR per score 1.25, 95% CI 1.12–1.39, p < 0.001), and wall-occiput distance (OR per cm 1.15, 95% CI 1.08–1.23, p < 0.001) were all associated with prevalent fracture.Conclusion.Semiquantitative methods are needed to improve the diagnosis of vertebral fractures in AS in order to start early treatment and to avoid complications arising from osteoporosis.

Download Full-text

OP0255 THE ROLE OF PELVIC MORPHOLOGY IN AXIAL SPONDYLOARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.188 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 156.1-156

Author(s):

E. Zaccagnino ◽

R. Patel ◽

L. S. Gensler

Keyword(s):

New York ◽

Ankylosing Spondylitis ◽

Axial Spondyloarthritis ◽

Axial Skeleton ◽

Chronic Inflammatory Disease ◽

Cross Sectional ◽

Radiographic Damage ◽

Pelvic Morphology ◽

The Relationship

Background:Axial Spondyloarthritis (axSpA) is a chronic inflammatory disease affecting the axial skeleton. It includes non-radiographic axSpA and radiographic axSpA [Ankylosing Spondylitis (AS)]. Male axSpA patients often have greater damage, while women report a higher disease burden. The role of pelvic morphology in the axSpA phenotype has not been explored. There is anatomic sexual dimorphism between the male and female pelvis. Given the phenotypic gender differences in axSpA, the role of pelvic morphometry is of interest.Objectives:The purpose of this study is to determine whether an association exists between pelvic dimensions and radiographic damage in patients with axSpA, as well as to compare these measurements in axSpA patients and healthy controls.Methods:This was a cross-sectional analysis comparing axSpA cases from a prospective cohort and non-axSpA controls from the UCSF radiology databank. Informed consent was obtained from axSpA cohort patients and this study was approved by the institutional IRB. To be included in the analysis, we limited inclusion to age ≤ 50 with an Anterior Posterior (AP) pelvis radiograph in the system. We excluded non-nulliparity, pelvic fracture history, BMI ≥ 30kg/m2, any prosthetic history and avascular necrosis. We measured the pelvic inlet, pelvic outlet, and subpubic angle (based on validated scoring methods) (Figure 1) and assessed its relation to sacroiliac joint (SIJ) damage (average SIJ score, New York criteria) and modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) in cases. AxSpA patients were also compared to age/gender matched controls. Pelvic measurements were performed by 2 blinded independent-trained readers in randomized, blinded image order. Inter-rater reliability was assessed. When examining the relationship between pelvic measurements and damage, linear regression was used to stratify by gender and adjust for potential confounders.Results:The axSpA cohort included 481 patients, of which 210 men and 89 women were included in this analysis and gender/age matched controls. Rater inter-class correlation was above 0.70 for pelvic outlet and above 0.80 for other measures. Cases and controls were similar (Table 1). The regression analysis showed a significant relationship between the sub-pubic angle and damage in the spine (coeff=-0.342, p=0.003) in men with axSpA. A sensitivity analysis, excluding mSASSS outliers (mSASSS ≥ 16) upheld the relationship (coeff=-1.40, p=0.002).Conclusion:In men with axSpA, there appears to be a relationship between sub-pubic angle and spinal radiographic damage. This is consistent with our finding that women have larger sub-pubic angles and lower spinal radiographic damage than men. A greater sub-pubic angle may protect against spinal involvement or associate with other protective factors. Further work should be performed to understand the contribution of pelvic anatomy to damage in axSpA.Disclosure of Interests:Ethan Zaccagnino: None declared, Rina Patel: None declared, Lianne S. Gensler Consultant of: AbbVie, Eli Lilly, Gilead, Novartis, Pfizer and UCB., Grant/research support from: Pfizer and UCB.

Download Full-text

Severity of Sacroiliitis and Erythrocyte Sedimentation Rate are Associated with a Low Trabecular Bone Score in Young Male Patients with Ankylosing Spondylitis

The Journal of Rheumatology ◽

10.3899/jrheum.170079 ◽

2018 ◽

Vol 45 (3) ◽

pp. 349-356 ◽

Cited By ~ 9

Author(s):

Kwi Young Kang ◽

Min Kyung Chung ◽

Ha Neul Kim ◽

Yeon Sik Hong ◽

Ji Hyeon Ju ◽

...

Keyword(s):

New York ◽

Lumbar Spine ◽

Ankylosing Spondylitis ◽

Vertebral Fractures ◽

Structural Damage ◽

Trabecular Bone Score ◽

Young Male ◽

Erythrocyte Sedimentation ◽

Male Patients ◽

The Mean

Objective.To examine factors related to a low trabecular bone score (TBS) and the association between TBS and vertebral fractures in patients with ankylosing spondylitis (AS).Methods.One hundred patients (all male, aged < 50 yrs) who fulfilled the modified New York criteria for the classification of AS were enrolled. The TBS and bone mineral density (BMD) were assessed using dual-energy X-ray absorptiometry. Clinical variables, inflammatory markers, and the presence of vertebral fractures were also assessed. Sacroiliitis grade and spinal structural damage were measured using the modified New York criteria and the Stoke Ankylosing Spondylitis Spine Score (SASSS).Results.The mean TBS was 1.38 ± 0.13. The TBS showed a positive correlation with BMD at the lumbar spine, femoral neck, and total hip. TBS negatively correlated with SASSS, whereas BMD at the lumbar spine showed a positive correlation. A significant decrease in TBS values was observed in patients with spinal structural damage (p = 0.001). Univariate analysis identified disease duration, erythrocyte sedimentation rate (ESR), sacroiliitis grade, and SASSS as being associated with TBS. Multivariate analysis identified ESR and sacroiliitis grade as being independently associated with TBS (p = 0.006 and p < 0.001, respectively). Ten patients had morphometric vertebral fractures. The mean TBS was lower in patients with vertebral fractures than in age-matched patients without fractures (p = 0.028). Lower TBS predicted vertebral fractures (area under curve = 0.733, cutoff = 1.311).Conclusion.The TBS in young male patients with AS is associated with the ESR and severity of sacroiliitis. The TBS may be useful as a tool for assessing osteoporosis in AS.

Download Full-text

FRI0564 SERUM LEVELS OF IL-6 AND IL-8 IN ANKYLOSING SPONDYLITIS PATIENTS: ASSOCIATIONS WITH DISEASE ACTIVITY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3082 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 884.1-885

Author(s):

E. Aleksandrova ◽

A. Novikov ◽

P. Kulakova ◽

A. Dorofeev ◽

N. Savenkova ◽

...

Keyword(s):

New York ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Heart Diseases ◽

Elevated Serum ◽

Serum Levels ◽

Fecal Calprotectin ◽

Chronic Inflammatory Disease ◽

Control Group ◽

Inflammatory Bowel

Background:Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine and sacroiliac joints characterized by new bone formation (syndesmophytes) and ankyloses. In AS cases, along with the damage to the musculoskeletal system, impairment of other organs and systems is often observed (uveitis, inflammatory bowel and heart diseases). Pro-inflammatory cytokines (TNF-α, IL-6,-17,-23,-21,-22,-31) and chemokines (IL-8) are key pathogenic markers in AS.Objectives:The aims of the study were to determine the serum levels of IL-6 and IL-8 in AS and investigate their relationship with disease activity.Methods:We studied 140 patients (pts) with AS fulfilled modified New York criteria (1984); (102M/38F); median and interquartile range (25th—75th percentile) of age 43.0; 35.0-51.0 years; disease duration 6.0; 4.0-12.0 years; BASDAI - 5.4; 4.1-6.6; ASDAS ESR - 3.6; 2.6-4.4; ASDAS CRP - 3.8; 2.7-4.5; 86% HLA-27 positive. In 50% of pts with AS, inflammatory bowel diseases (IBD) (Crohn’s disease and ulcerative colitis) were diagnosed. The control group included 17 healthy donors (HC). The serum concentrations of IL-6 and IL-8 were detected by chemiluminescence immunoassay using IMMULATE 1000 analyzer (Siemens Healthcare Diagnostics, USA).Results:AS pts had significantly higher serum level of IL-6 than HC (4.3; 0.1-8.0 pg/ml vs 2.3; 0.1-2.7 pg/ml, p <0.006). The median concentration of IL-8 didn’t differ between AS pts and HC (10.5; 8.3-18.0 pg/ml vs 11.9; 8.2-18.3 pg/ml, p>0.05). The same levels of IL-6 and IL-8 were detected in AS with IBD and AS without signs of IBD (p>0.05). In AS pts, serum IL-6 concentration was positively correlated with ASDAS ESR (r = 0.3), ASDAS CRP (r = 0.3), ESR (r = 0.3) and CRP (r = 0.5) (p <0.05); IL-8 was negatively associated with presence of fecal calprotectin (r = -0.3) (p <0.05).Conclusion:Elevated serum concentration of IL-6 in AS is associated with clinical and laboratory markers of high inflammatory activity of the disease. The levels of IL-8 in the sera of AS patients were negatively correlated with the concentration of fecal calprotectin. Data on the relationship of IL-8 with the activity of the pathological process in AS require further study.Disclosure of Interests:Elena Aleksandrova: None declared, Alexander Novikov: None declared, Polina Kulakova: None declared, Aleksey Dorofeev: None declared, Nadezhda Savenkova: None declared, Evgeniy Volnukhin: None declared, Anton Kovshik: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche

Download Full-text

The pathogenesis of ankylosing spondylitis

Neurosurgical FOCUS ◽

10.3171/foc/2008/24/1/e3 ◽

2008 ◽

Vol 24 (1) ◽

pp. E3 ◽

Cited By ~ 18

Author(s):

Mohammed F. Shamji ◽

Mohammed Bafaquh ◽

Eve Tsai

Keyword(s):

Ankylosing Spondylitis ◽

Molecular Mimicry ◽

Human Leukocyte ◽

Axial Skeleton ◽

Chronic Inflammatory Disease ◽

The Body ◽

Hla B27 ◽

Leukocyte Antigen ◽

Molecular Events ◽

Microbial Tolerance

✓ Ankylosing spondylitis (AS) is a chronic inflammatory disease that can cause significant functional complications by affecting the sacroiliac joints and axial skeleton. Despite a longstanding knowledge about the familial associations of this disease, particularly among patients positive for human leukocyte antigen (HLA)–B27, the fundamental pathogenetic mechanism by which this disease arises in genetically susceptible individuals remains ill defined. Furthermore, the molecular predilection for characteristic articular site involvement remains under ongoing investigation. Current theories about the HLA-B27 association range from the presentation of novel arthritogenic peptides, to abnormal autoimmune stimulation, to anomalous microbial tolerance. The immune effectors of this damage include CD4+, CD8+, and natural killer cells, with marked heterogeneity at different sites. Biomechanical stresses may trigger this disease by exposing the body to previously immune-sequestered autoantigens or by providing a route for bacterial seeding. Environmental triggers such as infection have not been definitively established but may represent a primary pathogenic step in a molecular-mimicry process. In this article, the authors review the current literature on the origin and pathophysiology of AS, focusing on genetic and molecular associations, consequent pathomechanisms, and associated triggers. An improved understanding of the sequence of molecular events that predispose and initiate the onset of this disease will allow for more specific and targeted therapy and better avoidance of the significant side effects of systemic immunomodulation.

Download Full-text

The Role of Clinical and Ultrasound Enthesitis Scores in Ankylosing Spondylitis

Life ◽

10.3390/life11030218 ◽

2021 ◽

Vol 11 (3) ◽

pp. 218

Author(s):

Alesandra Florescu ◽

Vlad Pădureanu ◽

Dan Nicolae Florescu ◽

Anca Bobircă ◽

Lucian-Mihai Florescu ◽

...

Keyword(s):

New York ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

Clinical Score ◽

Chronic Inflammatory Disease ◽

Joint Involvement ◽

History Of ◽

Research Consortium

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory disease, part of the spondyloarthritis (SpA) group, characterized by axial (spine and sacroiliac joints), entheseal, and peripheral joint involvement, which is frequently associated with extra-articular manifestations. Material and Methods: The study included a number of 30 patients diagnosed with AS according to the New York modified criteria, with history of entheseal pain, hospitalized between 2016–2018 in the Department of Rheumatology of the Emergency County Hospital of Craiova. Results: Regarding the Belgrade Ultrasound Enthesitis Score (BUSES) score and the disease activity calculated using the Ankylosing Spondylitis Disease Activity Score (ASDAS), they did not show a statistically significant association (p = 0.738). Additionally, BUSES did not have a statistically significant association with the disease activity quantified by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score (p = 0.094). The Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC) clinical score was not statistically associated with ASDAS (p = 0.434) nor with BASDAI (p = 0.130). The SPARCC clinical score and the BUSES ultrasound score were statistically significantly associated, registering a value of p = 0.018. Conclusions: Our study proved a significant correlation between SPARCC and BUSES, although in literature the evidence is contrasting.

Download Full-text

Colonoscopic Findings and Histological Changes in Patients Suffering from Ankylosing Spondylitis with Normal Bowel Habit

TAJ Journal of Teachers Association ◽

10.3329/taj.v22i1.5012 ◽

1970 ◽

Vol 22 (1) ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

MM Hoque Chowdhury ◽

MKP Abdul Alim ◽

M Harun Or Rashid ◽

M Kamal ◽

Iftekhar Mahmood ◽

...

Keyword(s):

New York ◽

Ankylosing Spondylitis ◽

Observational Study ◽

Inflammatory Lesion ◽

Axial Skeleton ◽

Bowel Habit ◽

Histological Changes ◽

Inflammatory Lesions ◽

Normal Bowel ◽

Bowel Symptoms

Ankylosing Spondylitis is a form of spondyloarthropathies characterized by chronic inflammation of the joints of axial skeleton, manifested clinically by pain and progressive stiffening of spine. It is evidenced that sero-negative spondyloarthropathies are closely related with gut inflammatory lesions. This inflammatory gut lesions may be clinically silent or with abnormal bowel symptoms. This observational study was done with an intension to see the inflammatory gut lesions in ankylosing spondylitis patients having normal bowel habit. In this study thirty eight ankylosing spondylitis patients were selected by New York revised criteria having normal bowel habit. All patients were subjected to full colonoscopy with biopsy. Only 7.89% patient showed macroscopic abnormalities (Grade-1 & 2) and 15.87 % had microscopic non-granulomatous inflammatory lesion of grade1 &2 on biopsy. This study concluded that gut inflammatory lesions in ankylosing spondylitis patients with normal bowel habit is not remarkable. So before making concrete opinion, further large sized comparable study with & without bowel symptoms can be warranted. DOI: 10.3329/taj.v22i1.5012 TAJ 2009; 22(1): 01-04

Download Full-text

Kinesiotherapy in patients with ankylosing spondylitis

Journal of restorative medicine and rehabilitation ◽

10.38025/2078-1962-2020-96-2-18-23 ◽

2020 ◽

Vol 96 (2) ◽

pp. 18-23

Author(s):

R.R. Ahunova ◽

R.A. Bodrova

Keyword(s):

Quality Of Life ◽

Ankylosing Spondylitis ◽

Axial Skeleton ◽

Poor Quality ◽

Chronic Inflammatory Disease ◽

Functional Disorders ◽

Regular Group ◽

Permanent Disability ◽

Positive Effect

Ankylosing spondylitis is a chronic inflammatory disease from the group of spondylarthritis, characterized by damage to the predominantly axial skeleton, gradual formation of functional disorders of the spine and joints, leading to temporary or permanent disability and poor quality of life for patients, mostly young. In recent years, much attention has been paid to the study of the effectiveness of kinesitherapy in patients with ankylosing spondylitis. Studies have been conducted that confirmed the positive effect on the function of the spine and joints of regular exercises performed at home, regular group exercise and their combination with physiotherapy methods. However, due to the imperfect methodology of conducting these studies and the lack of a standardized approach in evaluating the effectiveness of therapy in these patients, further detailed researches are needed to select the required amount of kinesitherapy for patients with ankylosing spondylitis and develop a standardized assessment of its effectiveness.

Download Full-text

Oclusão Completa do Arco Aórtico em Paciente Portadora de Arterite de Takayasu e Espondilite Anquilosante / Total Aortic arch Occlusion in a Patient with Takayasu's Arteritis and Spondylitis Ankylosans

REVISTA CIÊNCIAS EM SAÚDE ◽

10.21876/rcsfmit.v5i1.496 ◽

1970 ◽

Vol 5 (1) ◽

pp. 52-60

Author(s):

Rodolfo Souza Cardoso ◽

Melissa Andreia de Moraes Silva ◽

Seleno Glauber de Jesus Silva ◽

Isabela de Godoy ◽

Isabella Seixas Cenci Marin

Keyword(s):

Ankylosing Spondylitis ◽

Digital Subtraction Angiography ◽

Takayasu Arteritis ◽

Functional Limitation ◽

Axial Skeleton ◽

Chronic Inflammatory Disease ◽

Systemic Hypertension ◽

Unknown Etiology ◽

Simultaneous Occurrence ◽

Digital Subtraction

Introdução: A Arterite de Takayasu (AT) é uma vasculite que acomete a aorta e seus principais ramos, principalmente as artérias carótidas e subclávias. A espondilite anquilosante (EA) por sua vez é uma doença inflamatória crônica, que acomete preferencialmente a coluna vertebral, evoluindo com rigidez e limitação funcional progressiva do esqueleto axial. A associação dessas duas doenças é rara e de difícil diagnóstico. Casuística: Relata-se o caso de uma paciente do sexo feminino, 49 anos, apresentando dor e rigidez da coluna vertebral, cefaleia, vertigem, ausência de pulsos em membros superiores e hipertensão arterial sistêmica. A Angio-TC de aorta revelou oclusão dos troncossupra-aórticos (TSA) e sinais de espondilopatia, caracterizados por sindesmófitos entre os corpos vertebrais e sinais de anquilose da articulação sacroilíaca. A angiografia por subtração digital confirmou a oclusão completa dos TSA em suas origens e extensa circulação colateral. Foi iniciado tratamento com imunosupressores e corticoide, além de tratamento da hipertensão arterial sistêmica, observando-se redução dos níveis pressóricos e melhora da cefaleia, porém com manutenção da dor lombar e do enrijecimento articular. Conclusão: A ocorrência concomitante de duas doenças aparentemente distintas como a AT e a EA deve ser interpretada como a manifestação de um estado inflamatório sistêmico de etiologia ainda não totalmente definida. Palavras-chave: Arterite de Takayasu, Espondilite Anquilosante, Aorta Torácica, Angiografia Digital, Aortografia, Tomografia Computadorizada por Raios X.ABSTRACTIntroduction: Takayasu Arteritis (TA) is a large-vessel vasculitis that affects the aorta and its main branches, especially the carotid and subclavian arteries. Ankylosing Spondylitis (AS) in turn is a chronic inflammatory disease, that mainly affects the spine, evolving with stiffness and progressive functional limitation of the axial skeleton. The association of these two diseases is rare and difficult to diagnose. Case Report: We report the case of a female patient, 49 years, with pain and stiffness of the spine, headache, dizziness, absence of pulses in the upper limbs and systemic hypertension. The CT angiography revealed occlusion of the aorta of the supra-aortic trunks (SAT) and signals of spondylopathy, characterized by syndesmophytes between vertebral bodies and signs of ankylosis of the sacroiliac joint. The digital subtraction angiography confirmed a complete occlusion of the TSA in its origins and extensive collateral circulation. Treatment was started with immunosuppressants and corticosteroids, and treatment of hypertension, with a reduction in blood pressure and improvement of headache, although a maintenance of low back pain and joint stiffness was observed. Conclusion: The simultaneous occurrence of two seemingly distinct diseases such as TA and AS should be interpreted as the manifestation of a systemic inflammatory condition of unknown etiology not yet fully defined.Keywords: Takayasu Arteritis, Ankylosing Spondylitis, Thoracic Aorta, Digital Subtraction Angiography, Aortography, X-Ray Computed Tomography.

Download Full-text

Ankylosing spondylitis

10.1093/med/9780199642489.003.0113 ◽

2013 ◽

Author(s):

Joachim Sieper

Keyword(s):

Ankylosing Spondylitis ◽

Axial Skeleton ◽

Chronic Inflammatory Disease ◽

Hla B27 ◽

Term Outcome ◽

Long Term Outcome ◽

Male Predominance ◽

Inflammatory Drugs ◽

Active Inflammation

Ankylosing spondylitis (AS) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2 and 0.8% and is strongly dependent on the prevalence of HLA B27 in a given population. For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. Most recently new classification criteria for axial spondyloarthritis (SpA) have been developed by the Assessement of Spondylo-Arthritis international Society (ASAS) which cover AS but also the earlier form of non-radiographic axial SpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers have been proven to be effective in the medical treatment of axial SpA, and international ASAS recommendations for the structured management of axial SpA have been published based on these two types of drugs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are not effective.

Download Full-text

Vertebral Fractures in Ankylosing Spondylitis Are Associated with Lower Bone Mineral Density in Both Central and Peripheral Skeleton

The Journal of Rheumatology ◽

10.3899/jrheum.120316 ◽

2012 ◽

Vol 39 (10) ◽

pp. 1987-1995 ◽

Cited By ~ 67

Author(s):

EVA KLINGBERG ◽

MATS GEIJER ◽

JAN GÖTHLIN ◽

DAN MELLSTRÖM ◽

MATTIAS LORENTZON ◽

...

Keyword(s):

Bone Mineral Density ◽

New York ◽

Ankylosing Spondylitis ◽

Femoral Neck ◽

Bone Mineral ◽

Vertebral Fractures ◽

Disease Duration ◽

Mineral Density ◽

Lateral Spine ◽

Peripheral Skeleton

Objective.To study the prevalence and risk factors for vertebral fractures (VF) in ankylosing spondylitis (AS) and the relation between VF, measures of disease activity, and bone mineral density (BMD) in different measurement sites.Methods.Patients with AS (modified New York criteria) underwent examination, answered questionnaires, and gave blood samples. Lateral spine radiographs were scored for VF (Genant score) and syndesmophyte formation through modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). BMD was measured with dual-energy x-ray absorptiometry in the hip, radius, and lumbar spine in anteroposterior and lateral projections with estimation of volumetric BMD (vBMD).Results.Two hundred four patients (57% men) with a mean age of 50 ± 13 years and disease duration 15 ± 11 years were included. VF were diagnosed in 24 patients (12%), but were previously noted clinically in only 3 of the 24. Patients with VF were significantly older (p = 0.004), had longer disease duration (p = 0.011), higher Bath Ankylosing Spondylitis Metrology Index (p = 0.011), mSASSS (p = 0.035), and Bath Ankylosing Spondylitis patient global score-2 (BASG-2) (p = 0.032) and were more often smokers (p = 0.032). All women with a VF were postmenopausal. BMD was significantly lower at all measuring sites in the patients with VF. In logistic regression, high BASG-2, low BMD in femoral neck, and low lumbar vBMD were independently associated with presence of VF.Conclusion.VF in AS are common but are often not diagnosed. VF are associated with advanced age, longstanding disease, impaired back mobility, syndesmophyte formation, and lower BMD in both the central and peripheral skeleton. BMD in the femoral neck, total hip, and estimated vBMD showed the strongest association with VF.

Download Full-text