Skip to main content
SpringerLink
Log in

Radiographic Progression in Ankylosing Spondylitis: From Prognostication to Disease Modification

  • Spondyloarthritis (M Khan, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Pain, functional limitation, and spinal damage are the three main domains that have significant impact on various aspects of axial spondyloarthritis (axSpA).

Recent Findings

Several randomized controlled trials (RCTs) showed a beneficial effect of non-steroid ant-inflammatory drugs (NSAIDs) and biologic treatments on pain and function. The effect of available treatments on spinal damage is still of interest and is being studied.

Summary

In this article, we review the literature on radiographic progression in axSpA. We discuss the natural course of spinal progression, predictors of spinal damage, and the effect of lifestyle changes and medications on radiographic progression in axSpA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984;27(4):361–8.

    Article  Google Scholar 

  2. Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777–83.

    Article  CAS  Google Scholar 

  3. Lories RJ, de Vlam K, Luyten FP. Are current available therapies disease-modifying in spondyloarthritis? Best Pract Res Clin Rheumatol. 2010;24(5):625–35.

    Article  Google Scholar 

  4. Braun J, van der Heijde D. Imaging and scoring in ankylosing spondylitis. Best Pract Res Clin Rheumatol. 2002;16(4):573–604.

    Article  CAS  Google Scholar 

  5. MacKay K, Mack C, Brophy S, Calin A. The Bath Ankylosing Spondylitis Radiology Index (BASRI): a new, validated approach to disease assessment. Arthritis Rheum. 1998;41(12):2263–70.

    Article  CAS  Google Scholar 

  6. Averns HL, Oxtoby J, Taylor HG, Jones PW, Dziedzic K, Dawes PT. Radiological outcome in ankylosing spondylitis: use of the Stoke Ankylosing Spondylitis Spine Score (SASSS). Br J Rheumatol. 1996;35(4):373–6.

    Article  CAS  Google Scholar 

  7. Creemers MC, Franssen MJ, van't Hof MA, Gribnau FW, van de Putte LB, van Riel PL. Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis. 2005;64(1):127–9.

    Article  CAS  Google Scholar 

  8. Wanders AJ, Landewe RB, Spoorenberg A, Dougados M, van der Linden S, Mielants H, et al. What is the most appropriate radiologic scoring method for ankylosing spondylitis? A comparison of the available methods based on the Outcome Measures in Rheumatology Clinical Trials filter. Arthritis Rheum. 2004;50(8):2622–32.

    Article  Google Scholar 

  9. Ramiro S, van Tubergen A, Stolwijk C, Landewé R, van de Bosch F, Dougados M, et al. Scoring radiographic progression in ankylosing spondylitis: should we use the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) or the Radiographic Ankylosing Spondylitis Spinal Score (RASSS)? Arthritis Res Ther. 2013;15(1):R14.

    Article  Google Scholar 

  10. van der Heijde D, Landewe R. Selection of a method for scoring radiographs for ankylosing spondylitis clinical trials, by the Assessment in Ankylosing Spondylitis Working Group and OMERACT. J Rheumatol. 2005;32(10):2048–9.

    PubMed  Google Scholar 

  11. Spoorenberg A, de Vlam K, van der Linden S, Dougados M, Mielants H, van de Tempel H, et al. Radiological scoring methods in ankylosing spondylitis. Reliability and change over 1 and 2 years. J Rheumatol. 2004;31(1):125–32.

    PubMed  Google Scholar 

  12. Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2011;70(6):896–904.

    Article  CAS  Google Scholar 

  13. Haroon N, Inman RD, Learch TJ, Weisman MH, Lee M, Rahbar MH, et al. The impact of tumor necrosis factor alpha inhibitors on radiographic progression in ankylosing spondylitis. Arthritis Rheum. 2013;65(10):2645–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Poddubnyy D, Haibel H, Listing J, Märker-Hermann E, Zeidler H, Braun J, et al. Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum. 2012;64(5):1388–98.

    Article  Google Scholar 

  15. Ramiro S, Stolwijk C, van Tubergen A, van der Heijde D, Dougados M, van den Bosch F, et al. Evolution of radiographic damage in ankylosing spondylitis: a 12 year prospective follow-up of the OASIS study. Ann Rheum Dis. 2015;74(1):52–9.

    Article  Google Scholar 

  16. Baraliakos X, Listing J, von der Recke A, Braun J. The natural course of radiographic progression in ankylosing spondylitis—evidence for major individual variations in a large proportion of patients. J Rheumatol. 2009;36(5):997–1002.

    Article  Google Scholar 

  17. Baraliakos X, Listing J, von der Recke A, Braun J. The natural course of radiographic progression in ankylosing spondylitis: differences between genders and appearance of characteristic radiographic features. Curr Rheumatol Rep. 2011;13(5):383–7.

    Article  Google Scholar 

  18. van Tubergen A, Ramiro S, van der Heijde D, Dougados M, Mielants H, Landewe R. Development of new syndesmophytes and bridges in ankylosing spondylitis and their predictors: a longitudinal study. Ann Rheum Dis. 2012;71(4):518–23.

    Article  Google Scholar 

  19. Baraliakos X, Listing J, Rudwaleit M, Brandt J, Sieper J, Braun J. Radiographic progression in patients with ankylosing spondylitis after 2 years of treatment with the tumour necrosis factor alpha antibody infliximab. Ann Rheum Dis. 2005;64(10):1462–6.

    Article  CAS  Google Scholar 

  20. van der Heijde D, Landewe R, Baraliakos X, Houben H, van Tubergen A, Williamson P, et al. Radiographic findings following two years of infliximab therapy in patients with ankylosing spondylitis. Arthritis Rheum. 2008;58(10):3063–70.

    Article  Google Scholar 

  21. van der Heijde D, Landewe R, Einstein S, Ory P, Vosse D, Ni L, et al. Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept. Arthritis Rheum. 2008;58(5):1324–31.

    Article  Google Scholar 

  22. van der Heijde D, Salonen D, Weissman BN, Landewé R, Maksymowych WP, Kupper H, et al. Assessment of radiographic progression in the spines of patients with ankylosing spondylitis treated with adalimumab for up to 2 years. Arthritis Res Ther. 2009;11(4):R127.

    Article  Google Scholar 

  23. Braun J, Baraliakos X, Hermann KG, Deodhar A, van der Heijde D, Inman R, et al. The effect of two golimumab doses on radiographic progression in ankylosing spondylitis: results through 4 years of the GO-RAISE trial. Ann Rheum Dis. 2014;73(6):1107–13.

    Article  CAS  Google Scholar 

  24. Baraliakos X, Haibel H, Listing J, Sieper J, Braun J. Continuous long-term anti-TNF therapy does not lead to an increase in the rate of new bone formation over 8 years in patients with ankylosing spondylitis. Ann Rheum Dis. 2014;73(4):710–5.

    Article  CAS  Google Scholar 

  25. Kim TJ, Shin JH, Kim S, Sung IH, Lee S, Song Y, et al. Radiographic progression in patients with ankylosing spondylitis according to tumor necrosis factor blocker exposure: Observation Study of Korean Spondyloarthropathy Registry (OSKAR) data. Joint Bone Spine. 2016;83(5):569–72.

    Article  CAS  Google Scholar 

  26. Braun J, Baraliakos X, Deodhar A, Baeten D, Sieper J, Emery P, et al. Effect of secukinumab on clinical and radiographic outcomes in ankylosing spondylitis: 2-year results from the randomised phase III MEASURE 1 study. Ann Rheum Dis. 2017;76(6):1070–7.

    Article  CAS  Google Scholar 

  27. Poddubnyy D, Sieper J. What is the best treatment target in axial spondyloarthritis: tumour necrosis factor alpha, interleukin 17, or both? Rheumatology (Oxford). 2018;57(7):1145–50.

  28. Dougados M, van der Heijde D, Sieper J, Braun J, Maksymowych WP, Citera G, et al. Symptomatic efficacy of etanercept and its effects on objective signs of inflammation in early nonradiographic axial spondyloarthritis: a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2014;66(8):2091–102.

    Article  CAS  Google Scholar 

  29. Song IH, Hermann KG, Haibel H, Althoff CE, Poddubnyy D, Listing J, et al. Prevention of new osteitis on magnetic resonance imaging in patients with early axial spondyloarthritis during 3 years of continuous treatment with etanercept: data of the ESTHER trial. Rheumatology (Oxford). 2015;54(2):257–61.

    Article  CAS  Google Scholar 

  30. van der Heijde D, Baraliakos X, Hermann KA, Landewé RBM, 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 randomised trial. Ann Rheum Dis. 2018;77(5):699–705.

    Article  Google Scholar 

  31. Sieper J, Baraliakos X, Listing J, Brandt J, Haibel H, Rudwaleit M, et al. Persistent reduction of spinal inflammation as assessed by magnetic resonance imaging in patients with ankylosing spondylitis after 2 yrs of treatment with the anti-tumour necrosis factor agent infliximab. Rheumatology (Oxford). 2005;44(12):1525–30.

    Article  CAS  Google Scholar 

  32. Maksymowych WP, Salonen D, Inman RD, Rahman P, Lambert RG. Low-dose infliximab (3 mg/kg) significantly reduces spinal inflammation on magnetic resonance imaging in patients with ankylosing spondylitis: a randomized placebo-controlled study. J Rheumatol. 2010;37(8):1728–34.

    Article  CAS  Google Scholar 

  33. Lambert RG, Salonen D, Rahman P, Inman RD, Wong RL, Einstein SG, et al. Adalimumab significantly reduces both spinal and sacroiliac joint inflammation in patients with ankylosing spondylitis: a multicenter, randomized, double-blind, placebo-controlled study. Arthritis Rheum. 2007;56(12):4005–14.

    Article  CAS  Google Scholar 

  34. Barkham N, Keen HI, Coates LC, O'Connor P, Hensor E, Fraser AD, et al. Clinical and imaging efficacy of infliximab in HLA-B27-positive patients with magnetic resonance imaging-determined early sacroiliitis. Arthritis Rheum. 2009;60(4):946–54.

    Article  CAS  Google Scholar 

  35. Braun J, Baraliakos X, Hermann KG, van der Heijde D, Inman RD, Deodhar AA, et al. Golimumab reduces spinal inflammation in ankylosing spondylitis: MRI results of the randomised, placebo-controlled GO-RAISE study. Ann Rheum Dis. 2012;71(6):878–84.

    Article  CAS  Google Scholar 

  36. Maksymowych WP, Chiowchanwisawakit P, Clare T, Pedersen SJ, Ostergaard M, Lambert RG. Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: evidence of a relationship between inflammation and new bone formation. Arthritis Rheum. 2009;60(1):93–102.

    Article  Google Scholar 

  37. Pedersen SJ, Chiowchanwisawakit P, Lambert RG, Ostergaard M, Maksymowych WP. Resolution of inflammation following treatment of ankylosing spondylitis is associated with new bone formation. J Rheumatol. 2011;38(7):1349–54.

    Article  CAS  Google Scholar 

  38. Baraliakos X, Heldmann F, Callhoff J, Listing J, Appelboom T, Brandt J, et al. Which spinal lesions are associated with new bone formation in patients with ankylosing spondylitis treated with anti-TNF agents? A long-term observational study using MRI and conventional radiography. Ann Rheum Dis. 2014;73(10):1819–25.

    Article  CAS  Google Scholar 

  39. Machado PM, Baraliakos X, van der Heijde D, Braun J, Landewe R. MRI vertebral corner inflammation followed by fat deposition is the strongest contributor to the development of new bone at the same vertebral corner: a multilevel longitudinal analysis in patients with ankylosing spondylitis. Ann Rheum Dis. 2016;75(8):1486–93.

    Article  Google Scholar 

  40. Molnar C, Scherer A, Baraliakos X, de Hooge M, Micheroli R, Exer P, et al. TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort. Ann Rheum Dis. 2018;77(1):63–9.

    Article  CAS  Google Scholar 

  41. Maas F, Arends S, Brouwer E, Essers I, van der Veer E, Efde M, et al. Reduction in spinal radiographic progression in ankylosing spondylitis patients receiving prolonged treatment with tumor necrosis factor inhibitors. Arthritis Care Res (Hoboken). 2017;69(7):1011–9.

    Article  CAS  Google Scholar 

  42. Baraliakos X, Braun J, Deodhar A, et al. SAT0268 Secukinumab demonstrates low radiographic progression and sustained efficacy through 4 years in patients with active ankylosing spondylitis. Ann Rheum Dis 2018;77:997–8.

  43. Braun J, Haibel H, de Hooge M, et al. SAT0259 Low rate of spinal radiographic progression over 2 years in ankylosing spondylitis patients treated with secukinumab: a historical cohort comparison. Ann Rheum Dis 2018;77:992–3.

  44. Effect of Secukinumab on Radiographic Progression in Ankylosing Spondylitis as Compared to GP2017 (Adalimumab Biosimilar) (SURPASS). https://clinicaltrials.gov/ct2/show/NCT03259074

  45. van der Heijde D, Ramiro S, Landewe R, Baraliakos X, Van den Bosch F, Sepriano A, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978–91.

    Article  Google Scholar 

  46. van der Heijde D, Baraf HS, Ramos-Remus C, Calin A, Weaver AL, Schiff M, et al. Evaluation of the efficacy of etoricoxib in ankylosing spondylitis: results of a fifty-two-week, randomized, controlled study. Arthritis Rheum. 2005;52(4):1205–15.

    Article  Google Scholar 

  47. Sari I, Ozturk MA, Akkoc N. Treatment of ankylosing spondylitis. Turk J Med Sci. 2015;45(2):416–30.

    Article  CAS  Google Scholar 

  48. Haroon N, Kim TH, Inman RD. NSAIDs and radiographic progression in ankylosing spondylitis bagging big game with small arms? Ann Rheum Dis. 2012;71(10):1593–5.

    Article  Google Scholar 

  49. Boersma JW. Retardation of ossification of the lumbar vertebral column in ankylosing spondylitis by means of phenylbutazone. Scand J Rheumatol. 1976;5(1):60–4.

    CAS  PubMed  Google Scholar 

  50. Wanders A, Heijde D, Landewe R, Béhier JM, Calin A, Olivieri I, et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: a randomized clinical trial. Arthritis Rheum. 2005;52(6):1756–65.

    Article  CAS  Google Scholar 

  51. Kroon F, Landewe R, Dougados M, van der Heijde D. Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis. Ann Rheum Dis. 2012;71(10):1623–9.

    Article  CAS  Google Scholar 

  52. Poddubnyy D, Rudwaleit M, Haibel H, Listing J, Märker-Hermann E, Zeidler H, et al. Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort. Ann Rheum Dis. 2012;71(10):1616–22.

    Article  CAS  Google Scholar 

  53. Sieper J, Listing J, Poddubnyy D, Song IH, Hermann KG, Callhoff J, et al. Effect of continuous versus on-demand treatment of ankylosing spondylitis with diclofenac over 2 years on radiographic progression of the spine: results from a randomised multicentre trial (ENRADAS). Ann Rheum Dis. 2016;75(8):1438–43.

    Article  CAS  Google Scholar 

  54. Taylor HG, Beswick EJ, Dawes PT. Sulphasalazine in ankylosing spondylitis. A radiological, clinical and laboratory assessment. Clin Rheumatol. 1991;10(1):43–8.

    Article  CAS  Google Scholar 

  55. Ramiro S, Landewe R, van Tubergen A, Boonen A, Stolwijk C, Dougados M, et al. Lifestyle factors may modify the effect of disease activity on radiographic progression in patients with ankylosing spondylitis: a longitudinal analysis. RMD Open. 2015;1(1):e000153.

    Article  Google Scholar 

  56. Jones GT, Ratz T, Dean LE, Macfarlane GJ, Atzeni F. Disease severity in never smokers, ex-smokers, and current smokers with axial spondyloarthritis: results from the Scotland Registry for Ankylosing Spondylitis. Arthritis Care Res (Hoboken). 2017;69(9):1407–13.

    Article  Google Scholar 

  57. Ward MM. Predictors of the progression of functional disability in patients with ankylosing spondylitis. J Rheumatol. 2002;29(7):1420–5.

    PubMed  Google Scholar 

  58. Ciurea A, Scherer A, Weber U, Exer P, Bernhard J, Tamborrini G, et al. Impaired response to treatment with tumour necrosis factor alpha inhibitors in smokers with axial spondyloarthritis. Ann Rheum Dis. 2016;75(3):532–9.

    Article  CAS  Google Scholar 

  59. Villaverde-Garcia V, Cobo-Ibanez T, Candelas-Rodriguez G, Seoane-Mato D, PDD C-F, Guerra M, et al. The effect of smoking on clinical and structural damage in patients with axial spondyloarthritis: a systematic literature review. Semin Arthritis Rheum. 2017;46(5):569–83.

    Article  Google Scholar 

  60. Wendling D, Prati C. Spondyloarthritis and smoking: towards a new insight into the disease. Expert Rev Clin Immunol. 2013;9(6):511–6.

    Article  CAS  Google Scholar 

  61. 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.

    Article  Google Scholar 

  62. Poddubnyy D, Protopopov M, Haibel H, Braun J, Rudwaleit M, Sieper J. High disease activity according to the Ankylosing Spondylitis Disease Activity Score is associated with accelerated radiographic spinal progression in patients with early axial spondyloarthritis: results from the GErman SPondyloarthritis Inception Cohort. Ann Rheum Dis. 2016;75(12):2114–8.

    Article  Google Scholar 

  63. Landewe R, Dougados M, Mielants H, van der Tempel H, van der Heijde D. Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Ann Rheum Dis. 2009;68(6):863–7.

    Article  CAS  Google Scholar 

  64. Poddubnyy D, Listing J, Haibel H, Knuppel S, Rudwaleit M, Sieper J. Functional relevance of radiographic spinal progression in axial spondyloarthritis: results from the GErman SPondyloarthritis Inception Cohort. Rheumatology (Oxford). 2018;57(4):703–11.

    Article  Google Scholar 

  65. Poddubnyy D, Fedorova A, Listing J, Haibel H, Baraliakos X, Braun J, et al. Physical function and spinal mobility remain stable despite radiographic spinal progression in patients with ankylosing spondylitis treated with TNF-alpha inhibitors for up to 10 years. J Rheumatol. 2016;43(12):2142–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey

    Ismail Sari

  2. Division of Rheumatology, Toronto Western Hospital, University of Toronto, 399 Bathurst St, Toronto, ON, M5T2S8, Canada

    Ismail Sari & Nigil Haroon

  3. Krembil Research Institute, University Health Network, University of Toronto, Toronto, Canada

    Nigil Haroon

Authors
  1. Ismail Sari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nigil Haroon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ismail Sari.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Spondyloarthritis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sari, I., Haroon, N. Radiographic Progression in Ankylosing Spondylitis: From Prognostication to Disease Modification. Curr Rheumatol Rep 20, 82 (2018). https://doi.org/10.1007/s11926-018-0795-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-018-0795-4

Keywords

Search

Navigation