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. 2023 Feb;9(1):e002836.
doi: 10.1136/rmdopen-2022-002836.

Inflammation, bone loss and 2-year bone formation at the same vertebra in axial spondyloarthritis: a multilevel MRI and low-dose CT analysis

Mary Lucy Marques  1   2 , Nuno Pereira da Silva  3 , Desirée van der Heijde  4 , Rosalinde Stal  4 , Xenofon Baraliakos  5 , Juergen Braun  5 , Monique Reijnierse  6 , Caroline Bastiaenen  7 , Sofia Ramiro  4   8 , Floris A van Gaalen  4
Affiliations

Inflammation, bone loss and 2-year bone formation at the same vertebra in axial spondyloarthritis: a multilevel MRI and low-dose CT analysis

Mary Lucy Marques et al. RMD Open. 2023 Feb.

Abstract

Objective: To investigate whether in radiographic axial spondyloarthritis (r-axSpA) inflammation is associated with lower trabecular bone density (TBD), and subsequently, if a lower TBD increases the likelihood of 2-year bone formation at the same vertebra.

Methods: Whole spine (C3-L5) data from patients included in the multicentre 2-year Sensitive Imaging in Ankylosing Spondylitis cohort was used. Two readers measured baseline TBD by Hounsfield units (HU) on low-dose CT (ldCT). Baseline MRI bone marrow oedema (BME) status scores and ldCT syndesmophyte formation and/or growth change-from-baseline scores were assessed by three and two readers, respectively. Average of readers' continuous measurements or readers' agreement in binary scores generated within the same vertebra (1-present in ≥1 quadrant/0-absent in all quadrants) were used. Multilevel generalised estimating equations models were used, the unit of analysis being the vertebra.

Results: In 50 patients with r-axSpA, TBD HU decreased from cranial to caudal vertebrae. Baseline MRI-BME was present in 300/985 (30%) and syndesmophytes in 588/910 (65%) vertebrae, both most prevalent at thoracolumbar region. Syndesmophyte formation or growth was observed in 18% of at-risk vertebrae (124/691). A significant confounder-adjusted association was found between inflammation and lower TBD (regression coefficient=-51; 95% CI-63 to -39). TBD was not associated with 2-year syndesmophyte formation or growth (adjusted OR 1.00; 95% CI 0.99 to 1.00).

Conclusion: In r-axSpA, while vertebral inflammation was associated with lower vertebral TBD, lower vertebral TBD itself did not increase the risk for new bone formation at the same vertebra. In preventing syndesmophyte progression, targeting local inflammation seems more important than targeting vertebral trabecular bone loss.

Keywords: Inflammation; Outcome Assessment, Health Care; Spondylitis, Ankylosing.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Transformation of scores from the vertebral unit level (A) to the same vertebra (B). MRI bone marrow oedema and CT syndesmophyte scores were performed at the vertebral unit level. A vertebral unit consists of the lower half of a vertebra, the intervertebral disc space and the upper half of the next vertebra (A). For the current study, to match the measurements of bone density Hounsfield units, the analyses were performed at the same vertebra, that is considering the sum scores of the upper half and lower half of the same vertebra (B).
Figure 2
Figure 2
Directed acyclic graphs for the tested associations. Minimal sufficient adjustment sets for estimating the total effect of MRI inflammation on low bone density (A): age, gender, treatment with TNF inhibitors and syndesmophytes at baseline. Minimal sufficient adjustment sets for estimating the total effect of low bone density on 2-year bone formation: age, gender, MRI vertebral inflammation, smoking, treatment with TNF inhibitors and presence of syndesmophytes at baseline. BMD, bone mineral density; BMI, body mass index; IBD, inflammatory bowel disease; TNF, tumour necrosis factor.
See this image and copyright information in PMC

References

    1. Navarro-Compán V, Sepriano A, El-Zorkany B, et al. Axial spondyloarthritis. Ann Rheum Dis 2021;80:1511–21. 10.1136/annrheumdis-2021-221035 - DOI - PubMed
    1. Machado P, Landewé R, Braun J, et al. Both structural damage and inflammation of the spine contribute to impairment of spinal mobility in patients with ankylosing spondylitis. Ann Rheum Dis 2010;69:1465–70. 10.1136/ard.2009.124206 - DOI - PubMed
    1. Van Mechelen M, Gulino GR, de Vlam K, et al. Bone disease in axial spondyloarthritis. Calcif Tissue Int 2018;102:547–58. 10.1007/s00223-017-0356-2 - DOI - PubMed
    1. Ramiro S, van Tubergen A, van der Heijde D, et al. Brief report: erosions and sclerosis on radiographs precede the subsequent development of syndesmophytes at the same site: a twelve-year prospective followup of patients with ankylosing spondylitis. Arthritis Rheumatol 2014;66:2773–9. 10.1002/art.38775 - DOI - PubMed
    1. Moltó A, Nikiphorou E. Comorbidities in spondyloarthritis. Front Med (Lausanne) 2018;5:62. 10.3389/fmed.2018.00062 - DOI - PMC - PubMed

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