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21-06-2018 | Axial spondyloarthritis | Review | Article

Better Quantification of Syndesmophyte Growth in Axial Spondyloarthritis

Journal: Current Rheumatology Reports

Authors: Michael M. Ward, Sovira Tan

Publisher: Springer US

Abstract

Purpose of review

We review new insights to syndesmophyte growth in axial spondyloarthritis revealed by computed tomography (CT).

Recent findings

CT allows full reliable quantitation of syndesmophytes. About 70% of patients had detectable growth in syndesmophyte volume or height in 1 year. Syndesmophyte growth is not uniform, but can be highly heterogeneous even within the same disc space of the same patient. Syndesmophytes are not randomly distributed around the vertebral rim but have preferred locations (posterolateral and anterolateral) which vary along the spine. The frequency of syndesmophyte involvement also varies along the spine. It is highest at the thoracolumbar junction and higher in the thoracic than lumbar spine.

Summary

CT syndesmophyte quantitation is a promising tool for studies of medications or biomarkers and their relations with syndesmophyte progression. The localization and growth patterns of syndesmophytes suggest importance for local factors such as mechanical stress.
Literature
1.
Braun J, Baraliakos X, Golder W, Brandt J, Rudwaleit M, Listing J, et al. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthritis Rheum. 2003;48:1126–36.CrossRefPubMed
2.
Bochkova AG, Levshakova AV, Bunchuk NV, Braun J. Spinal inflammation lesions as detected by magnetic resonance imaging in patients with early ankylosing spondylitis are more often observed in posterior structures of the spine. Rheumatology. 2010;49:749–55.CrossRefPubMed
3.
Jang JH, Ward MM, Rucker AN, Reveille JD, Davis JC Jr, Weisman MH, et al. Ankylosing spondylitis: patterns of radiographic involvement—a re-examination of accepted principles in a cohort of 769 patients. Radiology. 2011;258:192–8.CrossRefPubMedPubMedCentral
4.
van der Heijde D, Landewé R, Baraliakos X, Houben H, Tubergen AV, Williamson P, et al. Radiographic findings following two years of infliximab therapy in patients with ankylosing spondylitis. Arthritis Rheum. 2008;58:3063–70.CrossRefPubMed
5.
van der Heijde D, Landewé 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;58:1324–31.CrossRefPubMed
6.
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:R127.CrossRefPubMedPubMedCentral
7.
Haroon N, Inman RD, Learch TJ, Weisman MH, Lee M, Rahbar MH, et al. The impact of tumor necrosis factor α inhibitors on radiographic progression in ankylosing spondylitis. Arthritis Rheum. 2013;65:2645–54.PubMedPubMedCentral
8.
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;83:569–72.CrossRefPubMed
9.
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;73:1455–61.CrossRefPubMed
10.
Wanders A, van der Heijde D, Landewé 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;52:1756–65.CrossRefPubMed
11.
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;75:1438–43.CrossRefPubMed
12.
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;71:1616–22.CrossRefPubMed
13.
Baraliakos X, Listing J, Rudwaleit M, Sieper J, Braun J. Development of a radiographic scoring tool for ankylosing spondylitis only based on bone formation: addition of the thoracic spine improves sensitivity to change. Arthritis Care Res. 2009;61:764–71.CrossRef
14.
Wanders AJ, Landewé R, Spoorenberg A, Dougados M, van der Linden S, Mielants H, et al. What is the most appropriate radiologic scoring method for ankylosing spondylitis? Arthritis Rheum. 2004;50:2622–32.CrossRefPubMed
15.
Salaffi F, Carotti M, Garofalo G, Giuseppetti GM, Grassi W. Radiological scoring methods for ankylosing spondylitis: a comparison between the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score. Clin Exp Rheumatol. 2007;25:67–74.PubMed
16.
Başkan BM, Sivas F, Inal EE, Duran S, Elverici E, Ozoran K, et al. Comparison of the Bath Ankylosing Spondylitis Radiology Index and the modified Stoke Ankylosing Spondylitis Spine Score in Turkish patients with ankylosing spondylitis. Clin Rheumatol. 2010;29:65–70.CrossRefPubMed
17.
Ulusoy H, Kaya A, Kamanli A, Akgol G, Ozgocmen S. Radiological scoring methods in ankylosing spondylitis: a comparison of the reliability of available methods. Acta Reumatol Port. 2010;35:170–5.PubMed
18.
Claudepierre P, de Hooge MS, Feydy A, Reijnierse M, Saraux A, Dougados M, et al. Reliability of mSASSS scoring in everyday practice in DESIR-cohort study centres: cross-sectional study of agreement with trained readers. Ann Rheum Dis. 2016;75:2213–4.CrossRefPubMed
19.
Ward MM, Hendrey MR, Malley JD, Learch TJ, Davis JC, Reveille JD, et al. Clinical and immunogenetic prognostic factors for radiographic severity in ankylosing spondylitis. Arthritis Care Res. 2009;61:859–66.CrossRef
20.
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;64:1388–98.CrossRefPubMed
21.
Tan S, Yao J, Ward MM, Yao L, Summers RM. Computer aided evaluation of ankylosing spondylitis using high-resolution CT. IEEE Trans Med Imaging. 2008;27:1252–67.CrossRefPubMedPubMedCentral
22.
Tan S, Yao J, Yao L, Ward MM. Improved precision of syndesmophyte measurement for the evaluation of ankylosing spondylitis using CT: a phantom and patient study. Phys Med Biol. 2012;57:4683–704.CrossRefPubMedPubMedCentral
23.
Tan S, Yao J, Flynn JA, Yao L, Ward MM. Quantitation of circumferential syndesmophyte height along the vertebral rim in ankylosing spondylitis using computed tomography. J Rheumatol. 2015;42:472–8.CrossRefPubMed
24.
Tan S, Yao J, Flynn JA, Yao L, Ward MM. Quantitative measurement of syndesmophyte volume and height in ankylosing spondylitis using CT. Ann Rheum Dis. 2014;73:544–50.CrossRefPubMed
25.
•• Tan S, Yao J, Flynn JA, Yao L, Ward MM. Quantitative syndesmophyte measurement in ankylosing spondylitis using CT: longitudinal validity and sensitivity to change over 2 years. Ann Rheum Dis. 2015;74:437–43. This study shows the high sensitivity to change of quantitative syndesmophyte measures using CT. CrossRefPubMed
26.
Liang MH, Fossel AH, Larson MG. Comparisons of five health status instruments for orthopedic evaluation. Med Care. 1990;28:632–42.CrossRefPubMed
27.
• Tan S, Yao J, Flynn JA, Yao L, Ward MM. Dynamics of syndesmophyte growth in AS as measured by quantitative CT: heterogeneity within and among vertebral disc spaces. Rheumatology. 2015;54:972–80. This study shows high heterogeneity in syndesmophyte growth rates even within the same disc space of the same patient. CrossRefPubMed
28.
Baraliakos X, Listing J, Rudwaleit M, Haibel H, Brandt J, Sieper J, et al. Progression of radiographic damage in patients with ankylosing spondylitis: defining the central role of syndesmophytes. Ann Rheum Dis. 2007;66:910–5.CrossRefPubMedPubMedCentral
29.
van Tubergen A, Ramiro S, van der Heijde D, Dougados M, Mielants H, Landewé R. Development of new syndesmophytes and bridges in ankylosing spondylitis and their predictors: a longitudinal study. Ann Rheum Dis. 2012;71:518–23.CrossRefPubMed
30.
•• Tan S, Dasgupta A, Yao J, Flynn JA, Yao L, Ward MM. Spatial distribution of syndesmophytes along the vertebral rim in ankylosing spondylitis: preferential involvement of the posterolateral rim. Ann Rheum Dis. 2016;75:1951–7. This study shows the spatial distribution of syndesmophytes along the vertebral rim is not random but has preferred locations. CrossRefPubMedPubMedCentral
31.
•• Tan S, Yao L, Ward MM. Thoracic syndesmophytes commonly occur in the absence of lumbar syndesmophytes in ankylosing spondylitis: a computed tomography study. J Rheumatol. 2017;44:1828–32. The first CT study of thoracic syndesmophytes. CrossRefPubMed
32.
Braun J, Baraliakos X, Golder W, Hermann KG, Listing J, Brandt J, et al. Analysing chronic spinal changes in ankylosing spondylitis: a systematic comparison of conventional x-rays with magnetic resonance imaging using established and new scoring systems. Ann Rheum Dis. 2004;63:1046–55.CrossRefPubMedPubMedCentral
33.
• de Bruin F, de Koning A, van der Berg R, Baraliakos X, Braun J, Ramiro S, et al. Development of the CT syndesmophyte score (CTSS) in patients with ankylosing spondylitis: data from the SIAS cohort. Ann Rheum Dis. 2018;77:371–7. The first study of syndesmophytes using low-dose CT. CrossRefPubMed