Surface Topography and Radiographic Spinal Damage in Radiographic Axial Spondyloarthritis
Association Between Static Spinal Posture Assessed by Surface Topography (DIERS) and Radiographic Structural Damage (Modified Stoke Ankylosing Spondylitis Spine Score, mSASSS) in Radiographic Axial Spondyloarthritis: A Cross-Sectional Study
Radiographic axial spondyloarthritis (r-axSpA) causes progressive structural damage of the spine, conventionally quantified on lateral cervical and lumbar radiographs using the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Repeated radiography entails cumulative radiation exposure, substantial inter-reader variability and low sensitivity in early disease. DIERS Formetric 4D (four-dimensional) surface topography (DIERS International GmbH, Schlangenbad, Germany) provides radiation-free three-dimensional modelling of the spine and pelvis. The association between sagittal balance and structural damage has been demonstrated with a radiation-based biplanar low-dose radiography system (EOS imaging, Paris, France), but whether a radiation-free topographic method reflects the same association has not been investigated.
This single-centre, cross-sectional observational study will enrol 53 adults with r-axSpA fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria with radiographic sacroiliitis according to the modified New York criteria. At a single study visit, static DIERS Formetric 4D measurements, chest expansion, the Bath Ankylosing Spondylitis Metrology Index (BASMI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) are obtained. mSASSS is scored by a single reader, blinded to clinical and topographic data, on existing lateral cervical and lumbar radiographs obtained within the preceding 12 months; no additional radiographs are performed for the study. The primary analysis is the correlation between total mSASSS and the DIERS flèche cervicale (cervical sagittal anterior displacement).
Studie Overzicht
Toestand
Toestand
Conditie
Conditie
Interventie / Behandeling
Interventie / Behandeling
Gedetailleerde beschrijving
Design: single-centre, cross-sectional, non-interventional correlation study in a single patient group; no control group. All participant data are collected in one assessment session lasting approximately 45 to 60 minutes.
Measurements: (a) demographic and anthropometric data; (b) disease duration, age at symptom onset, comorbidities, extra-articular involvement (uveitis, inflammatory bowel disease, psoriasis), human leukocyte antigen B27 (HLA-B27) status, current medication category; (c) radiographic sacroiliitis grade according to the modified New York criteria and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS; range 0 to 72), scored by a single reader blinded to clinical and topographic data; (d) chest expansion; (e) the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP), the latter using routine C-reactive protein values with no additional blood sampling; (f) Bath Ankylosing Spondylitis Metrology Index (BASMI) total score and its five components; (g) DIERS Formetric 4D (four-dimensional) static parameters: flèche cervicale (cervical sagittal anterior displacement, mm), sagittal imbalance (mm and degrees), coronal imbalance (mm), pelvic obliquity (mm), pelvic torsion (degrees), cervical and lumbar depth distance (mm), kyphotic angle (degrees) and lordotic angle (degrees).
Statistical analysis: distribution is assessed with the Shapiro-Wilk test. The primary analysis is a Pearson or Spearman correlation between total mSASSS and flèche cervicale, reported with effect size and 95% confidence interval, followed by multiple linear regression adjusted for age and disease duration. Secondary analyses comprise correlations of DIERS parameters with clinical indices and an exploratory receiver operating characteristic analysis of the ability of DIERS sagittal parameters to predict mSASSS thresholds. The Benjamini-Hochberg procedure is applied to correct for multiple comparisons. Significance is set at p<0.05. Analyses are performed with IBM SPSS Statistics (Statistical Package for the Social Sciences) version 23 or later.
Sample size: calculated with G*Power 3.1.9 for a bivariate normal correlation model, two-tailed, correlation under the null hypothesis (rho H0) = 0, expected effect size r = 0.40, alpha = 0.05 and power = 0.85, giving a required sample of 53 participants (actual power 0.857). The effect size was set conservatively at r = 0.40 rather than the r = 0.61 reported by Wanders et al. (2005) for occiput-to-wall distance versus mSASSS, because DIERS parameters are not identical to clinical mobility measures.
Reporting follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.
Studietype
Studietype
Inschrijving (Geschat)
Inschrijving
Contacten en locaties
Studiecontact
Studiecontact
- Naam: Seyma Alkan, MD
- Telefoonnummer: +90 538 337 97 91
- E-mail: symalkan@gmail.com
Studie Contact Back-up
- Naam: Yasemin Tombak Yildizkan, MD
- Telefoonnummer: +90 505 402 97 63
- E-mail: yasemintombak@hotmail.com
Studie Locaties
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Yenimahalle
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Ankara, Yenimahalle, Turkije (Türkiye), 06560
- Werving
- Ankara Etlik City Hospital, Department of Physical Medicine and Rehabilitation
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Contact:
- Seyma Alkan, Medical Doctor
- Telefoonnummer: +90 5383379791
- E-mail: symalkan@gmail.com
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Deelname Criteria
Geschiktheidscriteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Bemonsteringsmethode
Studie Bevolking
Consecutive patients with radiographic axial spondyloarthritis attending the spondyloarthritis outpatient clinic of the Department of Physical Medicine and Rehabilitation, Ankara Etlik City Hospital.
Beschrijving
Inclusion Criteria:
- Age 18 to 65 years
- Diagnosis of radiographic axial spondyloarthritis fulfilling the Assessment of SpondyloArthritis international Society (ASAS) criteria, confirmed by radiographic sacroiliitis according to the modified New York criteria
- Able to provide written informed consent and to complete the assessments
- Available lateral cervical and lumbar radiographs obtained within the 12 months preceding the DIERS measurement
Exclusion Criteria:
- Neurological disease affecting balance, posture or gait (for example Parkinson disease, amyotrophic lateral sclerosis, cerebellar or vestibular disorders, history of stroke)
- History of lower extremity joint arthroplasty (hip or knee)
- Orthopaedic conditions affecting posture, balance or gait (ununited fracture, previous spinal or lower extremity surgery)
- Advanced cardiopulmonary disease, active infection or malignancy
- Pregnancy
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Observatiemodellen: CASE_ONLY
- Tijdsperspectieven: CROSS_SECTIONAL
Aantal groepen / cohorten
Cohorten en interventies
Groep / CohortGroep / Cohort |
Interventie / BehandelingInterventie / Behandeling |
|---|---|
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Radiographic axial spondyloarthritis patients
Adults aged 18 to 65 years with radiographic axial spondyloarthritis fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria with radiographic sacroiliitis according to the modified New York criteria, attending the spondyloarthritis outpatient clinic. All participants undergo a single assessment session including static DIERS Formetric 4D surface topography, chest expansion and clinical indices: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP). The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) is scored on existing lateral cervical and lumbar radiographs obtained within the preceding 12 months; no additional radiographs are taken. |
Radiation-free three-dimensional assessment of spinal and pelvic surface topography performed once in standing position. No radiation, no contact, no intervention on treatment. |
Wat meet het onderzoek?
Primaire uitkomstmaten
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Correlation between total mSASSS and DIERS fleche cervicale
Tijdsspanne: Single assessment session (Day 1); mSASSS scored on radiographs obtained within the 12 months preceding the assessment
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Total modified Stoke Ankylosing Spondylitis Spine Score (mSASSS; range 0 to 72, higher scores indicate greater structural damage), correlated with flèche cervicale (cervical sagittal anterior displacement, mm) measured by DIERS Formetric 4D surface topography. Reported as a correlation coefficient with magnitude, direction and 95% confidence interval. |
Single assessment session (Day 1); mSASSS scored on radiographs obtained within the 12 months preceding the assessment
|
Secundaire uitkomstmaten
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Correlation between DIERS sagittal parameters and BASMI
Tijdsspanne: Single assessment session (Day 1)
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Bath Ankylosing Spondylitis Metrology Index (range 0 to 10, higher scores indicate worse spinal mobility) correlated with DIERS Formetric 4D static parameters: fleche cervicale (mm), sagittal imbalance (mm and degrees), coronal imbalance (mm), pelvic obliquity (mm), pelvic torsion (degrees), cervical and lumbar depth distance (mm), kyphotic angle (degrees) and lordotic angle (degrees). |
Single assessment session (Day 1)
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Correlation between DIERS sagittal parameters and ASDAS-CRP
Tijdsspanne: Single assessment session (Day 1)
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Ankylosing Spondylitis Disease Activity Score with C-reactive protein (higher scores indicate greater disease activity) correlated with DIERS Formetric 4D static parameters: fleche cervicale (mm), sagittal imbalance (mm and degrees), coronal imbalance (mm), pelvic obliquity (mm), pelvic torsion (degrees), cervical and lumbar depth distance (mm), kyphotic angle (degrees) and lordotic angle (degrees). |
Single assessment session (Day 1)
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Correlation between total mSASSS and other DIERS Formetric static parameters
Tijdsspanne: Single assessment session (Day 1); mSASSS scored on radiographs obtained within the 12 months preceding the assessment
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Total modified Stoke Ankylosing Spondylitis Spine Score (mSASSS; range 0 to 72, higher scores indicate greater structural damage) correlated with the remaining DIERS Formetric 4D static parameters: sagittal imbalance (mm and degrees), coronal imbalance (mm), pelvic obliquity (mm), pelvic torsion (degrees), cervical depth distance (mm), lumbar depth distance (mm), kyphotic angle (degrees) and lordotic angle (degrees). Reported as correlation coefficients with 95% confidence intervals. |
Single assessment session (Day 1); mSASSS scored on radiographs obtained within the 12 months preceding the assessment
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Correlation between DIERS sagittal parameters and BASDAI
Tijdsspanne: Single assessment session (Day 1)
|
Bath Ankylosing Spondylitis Disease Activity Index (range 0 to 10, higher scores indicate greater disease activity) correlated with DIERS Formetric 4D static parameters: flèche cervicale (mm), sagittal imbalance (mm and degrees), coronal imbalance (mm), pelvic obliquity (mm), pelvic torsion (degrees), cervical and lumbar depth distance (mm), kyphotic angle (degrees) and lordotic angle (degrees). |
Single assessment session (Day 1)
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Correlation between DIERS sagittal parameters and BASFI
Tijdsspanne: Single assessment session (Day 1)
|
Bath Ankylosing Spondylitis Functional Index (range 0 to 10, higher scores indicate worse physical function) correlated with DIERS Formetric 4D static parameters: flèche cervicale (mm), sagittal imbalance (mm and degrees), coronal imbalance (mm), pelvic obliquity (mm), pelvic torsion (degrees), cervical and lumbar depth distance (mm), kyphotic angle (degrees) and lordotic angle (degrees). |
Single assessment session (Day 1)
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Correlation between DIERS sagittal parameters and chest expansion
Tijdsspanne: Single assessment session (Day 1)
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Chest expansion measured in centimetres correlated with DIERS Formetric 4D static parameters: flèche cervicale (mm), sagittal imbalance (mm and degrees), coronal imbalance (mm), pelvic obliquity (mm), pelvic torsion (degrees), cervical and lumbar depth distance (mm), kyphotic angle (degrees) and lordotic angle (degrees). |
Single assessment session (Day 1)
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Discriminative performance of DIERS sagittal parameters for mSASSS thresholds
Tijdsspanne: Single assessment session (Day 1); mSASSS scored on radiographs obtained within the 12 months preceding the assessment
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Exploratory receiver operating characteristic analysis of DIERS Formetric 4D sagittal parameters for discriminating total modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) thresholds. Reported as area under the curve with 95% confidence interval, sensitivity and specificity. |
Single assessment session (Day 1); mSASSS scored on radiographs obtained within the 12 months preceding the assessment
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Medewerkers en onderzoekers
Sponsor
Sponsor
Onderzoekers
Onderzoekers
- Hoofdonderzoeker: Ajda Bal, Professor of Physical Medicine and Rehabilitation
Publicaties en nuttige links
Algemene publicaties
- Turk E, Yurdakul FG, Guler T, Bodur H. Posture, balance and gait in axial spondyloarthritis: a case-control study. Rheumatol Int. 2024 Nov;44(11):2527-2538. doi: 10.1007/s00296-024-05710-5. Epub 2024 Sep 4.
- Oliveira TL, Silva FD, Filho AGO, Nico MAC, Fernandes ARC, Ramiro S, Pinheiro MM. Relationship between spinal structural damage and sagittal balance in axial spondyloarthritis: Is the thoracic spine the starting point? Semin Arthritis Rheum. 2024 Apr;65:152415. doi: 10.1016/j.semarthrit.2024.152415. Epub 2024 Feb 7.
- Wanders A, Landewe R, Dougados M, Mielants H, van der Linden S, van der Heijde D. Association between radiographic damage of the spine and spinal mobility for individual patients with ankylosing spondylitis: can assessment of spinal mobility be a proxy for radiographic evaluation? Ann Rheum Dis. 2005 Jul;64(7):988-94. doi: 10.1136/ard.2004.029728.
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Meer informatie
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Trefwoorden
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Andere studie-ID-nummers
Andere studie-ID-nummers
- AEŞH-BADEK1-2026-909
Plan Individuele Deelnemersgegevens (IPD)
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Individual participant data will not be shared. According to the study protocol, research data are accessible only to the investigators. Aggregate results will be published.
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