Spectrum of Radiographic Involvement in Axial Spondyloarthropathy Using the Modified Stokes Ankylosing Spondylitis Spine Score (MSASSS) and Modified Newyork Classification
DOI:
https://doi.org/10.21649/akemu.v31iSpl2.5785Keywords:
Ankylosing spondylitis( AS), Ankylosing spondylitis disease activity score –CRP (ASDAS-CRP), modified stoke ankylosing spondylitis spine score (mSASSS).Abstract
Background: Ankylosing spondylitis is a chronic debilitating inflammatory disease of the spine and it can lead to significant disability and morbidity in patients which can affect their quality of life.
Objectives: Modified Stokes Ankylosing Spondylitis Spinal Score (mSASSS) is a four-point (0-3) scoring system for lateral radiographs of the lumbar and cervical spine. The purpose of this study was to find out the mSASSS and the grade of sacroiliitis according to radiological criteria of MNYC in axial spondyloarthropathy patients.
Methods: This descriptive cross-sectional study wasdone in the Rheumatologyoutpatient department at the Federal Government Polyclinic Hospital Islamabad from January 2023 till July 2023. The data was recorded onto a proforma after informed consent. Patients underwent x-rays of the cervical, lumbar spine for finding the mSASSS and the sacroiliac joints in standard positions for sacroiliitis based on the modified NewYork classification. BASDAI and ASDAS-CRP scores were assessed.
Results: There were 40(86.9%) males and 6(13.1%) females. Of these, 27(58.7%) had a BASDAI score of ≥ 4 while 31 (67.3%) hadASDAS-CRP≥2.1 suggestive of active disease. The mean duration of disease was 6.51±4.43 years. The mean mSASSS of the patients was 9.69±17.99. Grade II and III sacroiliitis were the most frequent at 30.4% and 28.3% respectively as per the modified Newyork classification. The duration of disease, mSASSS(p=0.03) and the grade of sacroiliitis (p=0.015) showed a positive correlation.
Conclusion: The modified stokes ankylosing spondylitis spine score and the grade of sacroiliitis suggest the severity of the disease. The mean MSASS score in our patients was 9.69±17.99, while grade II and III were the most prevalent grades of sacroiliitis based on the MNYC.The modified Stokes Ankylosing spondylitis spine score and the grade of sacroiliitis correlated with the duration of the disease. Grade of sacroiliitis also correlated with the mSASS score.
References
1. Llop M, Rios Rodriguez V, Redeker I, Sieper J, Haibel H, Rudwaleit M, et al. Incorporation of the anteroposterior lumbar radiographs in the modified Stoke Ankylosing Spondylitis Spine Score improves detection of radiographic spinal progression in axial spondyloarthritis. Arthritis Res Ther. 2019;21:1–9. doi:10.1186/s13075-019-1862-6
2. Saeed MA, Ahmed H, Faiq M, Aslam Z, Khan SEA, Batool S, et al. Prevalence of inflammatory back pain and radiographic axial spondyloarthritis in a semi-urban community of Lahore, Pakistan. Int J Rheum Dis. 2021;24(2):207–15. doi:10.1111/1756-185X.14062
3. Ivanova M, Zimba O, Dimitrov I, Angelov AK, Georgiev T. Axial spondyloarthritis: an overview of the disease. Rheumatol Int. 2024;44(9):1607–19. doi:10.1007/s00296-024-05601-9
4. Wei JC, Chen HH, Hsieh TY, Lan HH, Tseng JC, Liu CH, et al. Clinical practice recommendations for the use of imaging in the diagnosis and management of axial spondyloarthritis in Taiwan. Int J Rheum Dis. 2020;23(1):24–36. doi:10.1111/1756-185X.13760
5. Lopez-Medina C, Ziade N. Axial disease in psoriatic arthritis: how can we define it, and does it have an impact on treatment? Mediterr J Rheumatol. 2022;33:142–9. doi:10.31138/mjr.33.1.142
6. Baraliakos X, Protopopov M, Rodriguez VR, Torgutalp M, Dilbaryan A, Haibel H, et al. Radiographic structural damage in axial spondyloarthritis: is there a preferred way to quantify progression over time? Comparison of blinded versus unblinded mSASSS scoring. Ann Rheum Dis. 2025;S0003-4967(25)00884-2. doi:10.1016/j.ard.2025.03.017
7. Van der Heijde D, Braun J, Deodhar A, Baraliakos X, Landewé R, Richards HB, et al. Modified Stoke Ankylosing Spondylitis Spinal Score as an outcome measure to assess the impact of treatment on structural progression in ankylosing spondylitis. Rheumatology. 2019;58(3):388–400. doi:10.1093/rheumatology/key284
8. Braun J, Haibel H, de Hooge M, Landewé R, Rudwaleit M, Fox T, et al. Spinal radiographic progression over 2 years in ankylosing spondylitis patients treated with secukinumab: a historical cohort comparison. Arthritis Res Ther. 2019;21(1):142. doi:10.1186/s13075-019-1911-1
9. Deminger A, Klingberg E, Geijer M, Göthlin J, Hedberg M, Rehnberg E, et al. A five-year prospective study of spinal radiographic progression and its predictors in men and women with ankylosing spondylitis. Arthritis Res Ther. 2018;20:1–4. doi:10.1186/s13075-018-1665-1
10. Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X, et al. Ankylosing spondylitis: Etiology, pathogenesis, and treatments. Bone Res. 2019;7(1):22. doi:10.1038/s41413-019-0057-8
11. Ramiro S, van der Heijde D, van Tubergen A, Stolwijk C, Dougados M, Van den Bosch F, et al. Higher disease activity leads to more structural damage in the spine in ankylosing spondylitis: 12-year longitudinal data from the OASIS cohort. Ann Rheum Dis. 2014;73(8):1455–61. doi:10.1136/annrheumdis-2013-204116
12. Essers I, van Tubergen A, Heldmann F, Baraliakos X, Braun J, Kiltz U, et al. Do patients with ankylosing spondylitis adapt to their disease? Evidence from a ‘then-test’ in patients treated with TNF inhibitors. RMD Open. 2015;1(1):e000153. doi:10.1136/rmdopen-2015-000153
13. Sepriano A, Ramiro S, Wichuk S, Chiowchanwisawakit P, Paschke J, van der Heijde D, et al. Tumor necrosis factor inhibitors reduce spinal radiographic progression in patients with radiographic axial spondyloarthritis: A longitudinal analysis from the Alberta prospective cohort. Arthritis Rheumatol. 2021;73(7):1211–9. doi:10.1002/art.41670
14. Ciurea A, Kissling S, Bürki K, Baraliakos X, de Hooge M, Hebeisen M, et al. Current differentiation between radiographic and non-radiographic axial spondyloarthritis is of limited benefit for prediction of important clinical outcomes. RMD Open. 2022;8(1):e001806. doi:10.1136/rmdopen-2021-001806
15. Sari I, Lee S, Tomlinson G, Johnson SR, Inman RD, Haroon N. Factors predictive of radiographic progression in ankylosing spondylitis. Arthritis Care Res (Hoboken). 2021;73(2):275–81. doi:10.1002/acr.24131
16. Karmacharya P, Duarte-Garcia A, Dubreuil M, Murad MH, Shahukhal R, Shrestha P, et al. Effect of therapy on radiographic progression in axial spondyloarthritis: A systematic review and meta-analysis. Arthritis Rheumatol. 2020;72(5):733–49. doi:10.1002/art.41191
17. Lee TH, Koo BS, Nam B, Oh JS, Park SY, Lee S, et al. Conventional disease-modifying antirheumatic drugs therapy may not slow spinal radiographic progression in ankylosing spondylitis: Results from an 18-year longitudinal dataset. Ther Adv Musculoskelet Dis. 2020;12:1–10. doi:10.1177/1759720X20924405
18. Koo BS, Oh JS, Park SY, Shin JH, Ahn GY, Lee S, et al. Tumor necrosis factor inhibitors slow radiographic progression in patients with ankylosing spondylitis: 18-year real-world evidence. Ann Rheum Dis. 2020;79(10):1327–32. doi:10.1136/annrheumdis-2020-217011
19. Baraliakos X, Gensler LS, D’Angelo S, Iannone F, Favalli EG, de Peyrecave N, et al. Biologic therapy and spinal radiographic progression in patients with axial spondyloarthritis: A structured literature review. Ther Adv Musculoskelet Dis. 2020;12:1–12. doi:10.1177/1759720X20906040
20. McInnes IB, Behrens F, Mease PJ, Kavanaugh A, Ritchlin C, Nash P, et al. Secukinumab versus adalimumab for treatment of active psoriatic arthritis (EXCEED): A double-blind, parallel-group, randomized, active-controlled, phase 3b trial. Lancet. 2020;395(10235):1496–505. doi:10.1016/S0140-6736(20)30564-X
21. Van der Heijde D, Baraliakos X, Hermann KG, Landewé RB, Machado PM, Maksymowych WP, et al. Limited radiographic progression and sustained reductions in MRI inflammation in patients with axial spondyloarthritis: 4-year imaging outcomes from the RAPID-axSpA phase III randomized trial. Ann Rheum Dis. 2018;77(5):699–705. doi:10.1136/annrheumdis-2017-212197
22. Pedersen SJ, Weber U, Said-Nahal R, Sørensen IJ, Loft AG, Kollerup G, et al. Structural progression rate decreases over time on serial radiography and magnetic resonance imaging in a five-year follow-up study of patients with ankylosing spondylitis treated with tumor necrosis factor inhibitor. Scand J Rheumatol. 2019;48(3):185–97. doi:10.1080/03009742.2018.1545181
23. Park JW, Kim MJ, Lee JS, Ha YJ, Park JK, Kang EH, et al. Impact of tumor necrosis factor inhibitor versus nonsteroidal anti-inflammatory drug treatment on radiographic progression in early ankylosing spondylitis. Arthritis Rheumatol. 2019;71(1):82–90. doi:10.1002/art.40675
24. Wang R, Bathon JM, Ward MM. Nonsteroidal anti-inflammatory drugs as potential disease-modifying medications in axial spondyloarthritis. Arthritis Rheumatol. 2020;72(4):518–28. doi:10.1002/art.41145
25. Hwang MC, Lee M, Gensler LS, Brown MA, Tahanan A, Rahbar MH, et al. Identifying trajectories of radiographic spinal disease in ankylosing spondylitis: A 15-year follow-up study of the PSOAS cohort. Rheumatology. 2022;61(5):2079–87. doi:10.1093/rheumatology/keab604
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