Relevance of structural damage in the sacroiliac joints for the functional status and spinal mobility in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort

Mikhail Protopopov, Joachim Sieper, Hildrun Haibel, Joachim Listing, Martin Rudwaleit, Denis Poddubnyy, Mikhail Protopopov, Joachim Sieper, Hildrun Haibel, Joachim Listing, Martin Rudwaleit, Denis Poddubnyy

Abstract

Background: Functional status and spinal mobility in patients with axial spondyloarthritis (axSpA) are known to be determined both by disease activity and by structural damage in the spine. The impact of structural damage in the sacroiliac joints (SIJ) on physical function and spinal mobility in axSpA has not been studied so far. The objective of the study was to analyze the impact of radiographic sacroiliitis on functional status and spinal mobility in patients with axSpA.

Methods: In total, 210 patients with axSpA were included in the analysis. Radiographs of SIJ obtained at baseline and after 2 years of follow up were scored by two trained readers according to the modified New York criteria grading system (grade 0-4). The mean of two readers' scores for each joint and a sum score for both SIJ were calculated for each patient giving a sacroiliitis sum score between 0 and 8. The Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Metrology Index (BASMI) at baseline and after 2 years were used as outcome measures.

Results: Longitudinal mixed model analysis adjusted for structural damage in the spine (modified Stoke Ankylosing Spondylitis Spine Score - mSASSS), disease activity (Bath Ankylosing Spondylitis Disease Activity Index - BASDAI and C-reactive protein level) and gender, revealed an independent association of the sacroiliitis sum score with the BASFI: b = 0.10 (95% CI 0.01-0.19) and the BASMI: b = 0.12 (95% CI 0.03-0.21), respectively, indicating that change by one radiographic sacroiliitis grade in one joint is associated with BASFI/BASMI worsening by 0.10/0.12 points, respectively, independently of disease activity and structural damage in the spine.

Conclusion: Structural damage in the SIJ might have an impact on functional status and spinal mobility in axSpA independently of spinal structural damage and disease activity.

Trial registration: ClinicalTrials.gov, NCT01277419 . Registered on 14 January 2011.

Keywords: Ankylosing spondylitis; Axial spondyloarthritis; BASFI; BASMI; Physical function; Sacroiliitis; Spinal mobility; Structural damage.

Conflict of interest statement

Ethics approval and consent to participate

The study was performed in accordance with the Declaration of Helsinki and was approved by the ethics committee of the coordinating center (Ethikkommission der Charité - Universitätsmedizin Berlin, Berlin, Germany, approval number: 188-19). Informed consent for the study participation was obtained from all patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Distribution of the sacroiliitis sum score at baseline (a) and change in the sacroiliitis sum score over 2 years (b) in 210 patients with axial spondyloarthritis
Fig. 2
Fig. 2
Combined cumulative probability and scatter plots depicting an association between the sacroiliitis sum score and the Bath Ankylosing Spondylitis Functional Index (BASFI) (a) or the Bath Ankylosing Spondylitis Metrology Index (BASMI) (b) at baseline in 210 patients with axial spondyloarthritis

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