Development and validation of 3 preliminary MRI sacroiliac joint composite structural damage scores in a 5-year longitudinal axial spondyloarthritis study
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Objective. In axial spondyloarthritis (axSpA), sacroiliac joint (SIJ) erosion is often followed by fat metaplasia in an erosion cavity (backfill), and subsequently ankylosis. We aimed to combine the Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ structural score for erosion, backfill, and ankylosis into 3 versions of a novel preliminary axSpA magnetic resonance imaging (MRI) SIJ Composite Structural Damage Score (CSDS) and to test these. Methods. Thirty-three patients with axSpA, followed for 5 years after initiation of tumor necrosis factor inhibitor, had MRIs of the SIJs at baseline, and yearly thereafter. Three versions of CSDS were calculated based on different weightings of erosion, backfill, and ankylosis: (1) equal weighting: CSDSequal = (erosion × 0.5) + backfill + ankylosis; (2) advanced stages weighting more: CSDSstepwise = (erosion × 1) + (backfill × 4) + (ankylosis × 6); and (3) advanced stages overruling earlier stages (“hierarchical”) with “<” meaning “overruled by”: CSDShierarchical = (erosion × 1) < (backfill × 4) < (ankylosis × 6). Results. At baseline, all CSDS correlated positively with SPARCC fat and ankylosis scores and modified New York radiography grading, and negatively with the Bath Ankylosing Spondylitis Disease Index and SPARCC SIJ inflammation scores. CSDSstepwise and CSDShierarchical (not CSDSequal) correlated positively with symptom duration and the Bath Ankylosing Spondylitis Metrology Index, and closer with SPARCC ankylosis score and modified New York radiography grading than CSDSequal. The adjusted annual progression rate for CSDSstepwise and CSDShierarchical (not CSDSequal) was higher the first year compared with fourth year (P = 0.04 and P = 0.01). Standardized response mean (baseline to Week 46) was moderate for CSDShierarchical (0.64) and CSDSstepwise (0.59) and small for CSDSequal (0.25). Conclusion. Particularly CSDSstepwise and CSDShierarchical showed construct validity and responsiveness, encouraging further validation in larger clinical trials. The potential clinical implication is assessment of SIJ damage progression by 1 composite score.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Journal of Rheumatology |
| Vol/bind | 48 |
| Udgave nummer | 10 |
| Sider (fra-til) | 1537-1546 |
| Antal sider | 10 |
| ISSN | 0315-162X |
| DOI | |
| Status | Udgivet - 2021 |
Bibliografisk note
Funding Information:
MØ has received research support, consultancy fees and/or speaker fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB. SJP has received speaker fees from MSD, Pfizer, AbbVie, Novartis, and UCB; has been an advisory board member for AbbVie and Novartis; and has received research support from AbbVie, MSD, and Novartis. AGL has been a consultant and advisor for AbbVie, Eli Lilly, MSD, Novartis, Pfizer, and UCB and has received speaker fees from AbbVie, MSD, Novartis, Pfizer, and UCB. GK has received speaker fees from Eli Lilly. MW, IJS, UW, LJ, GT, ORM, and JMM declare no conflicts of interest relevant to this article. Address correspondence to Dr. M. Wetterslev, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark. Email: marie.wetterslev@regionh.dk. Accepted for publication March 31, 2021.
Funding Information:
The Biomarkers in Spondylarthritis study (BIOSPA; ClinicalTrials.gov: NCT00133315) was conducted without any financial support. The Danish Rheumatism Association supported MW with a PhD fellowship grant (R131-A5381). 1M. Wetterslev, MD, M. Østergaard, MD, PhD, DMSc, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen, Copenhagen; 2I.J. Sørensen, MD, PhD, G. Kollerup, MD, PhD, L. Juul, MD, PhD, G. Thamsborg, MD, DMSc, O.R. Madsen, MD, PhD, DMSc, S.J. Pedersen, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen; 3U. Weber, MD, Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg, and Department of Regional Health Research, University of Southern Denmark, Odense; 4A.G. Loft, MD, PhD, Department of Rheumatology, Lillebælt Hospital, Vejle, Department of Rheumatology, Aarhus University Hospital, Aarhus; 5J.M. Møller, PhD, Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.
Publisher Copyright:
© 2021 The Journal of Rheumatology.
ID: 284200061