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Determining factors related to impaired spinal and hip mobility in patients with axial spondyloarthritis: longitudinal results from the DESIR cohort
  1. Pedro D Carvalho1,2,3,
  2. Adeline Ruyssen-Witrand4,
  3. Joao Fonseca2,5,
  4. Ana Marreiros3,6 and
  5. Pedro M Machado7,8,9
  1. 1Department of Rheumatology, Centro Hospitalar Universitário do Algarve, Faro, Portugal
  2. 2Rheumatology Research Unit, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
  3. 3Algarve Biomedical Center, Faro, Portugal
  4. 4Centre Hospitalier Universitaire de Toulouse, Toulouse, France
  5. 5Department of Rheumatology, Santa Maria Hospital - CHLN, Lisbon, Portugal
  6. 6Universidade do Algarve, Faro, Portugal
  7. 7Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK
  8. 8Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
  9. 9Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
  1. Correspondence to Pedro M Machado; p.machado{at}


Objective To investigate the determinants of impaired spinal and hip mobility in patients with early axial spondyloarthritis (axSpA).

Methods Five-year longitudinal data from the DEvenir des Spondyloarthrites Indifférenciées Récentes (DESIR) cohort were analysed. Associations were investigated using generalised estimating equations, using Bath Ankylosing Spondylitis Metrology Index (BASMI) linear or each of the five components of BASMI as dependent variables, and clinical and demographic variables as independent variables in univariable models. Multivariable analyses were performed, adjusting for potential confounders.

Results Data from 644 patients and 5152 visits were analysed. Higher BASMI values were independently and positively associated with Ankylosing Spondylitis Disease Activity Score C reactive protein (ASDAS-CRP) (adjusted B (adjB)=0.21; 95% CI=0.15 to 0.28), MRI spinal inflammation score (adjB=0.11; 95% CI=0.04 to 0.19), enthesitis score (adjB=0.02; 95% CI=0.01 to 0.04) and age (adjB=0.02; 95% CI=0.01 to 0.03). All BASMI components were independently associated with ASDAS-CRP and MRI spinal inflammation, except for maximal intermalleolar distance (reflecting hip mobility), which was not associated with MRI spinal inflammation.

Conclusion In early axSpA, spinal mobility impairment is independently determined by clinical disease activity, MRI spinal inflammation, enthesitis and age. The influence of spinal inflammation prevails in early axSpA, as opposed to spinal structural damage, which may become more relevant in later disease stages.

  • Spondylitis
  • Ankylosing
  • MRI
  • Patient Reported Outcome Measures

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  • Twitter Pedro M Machado @pedrommcmachado.

  • Contributors PDC and PMM designed the study. PDC cleaned the database and performed the statistical analyses under the supervision of AM and PMM. PDC and PMM drafted the first version of the manuscript. All those listed as authors read, commented on and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Pedro M Machado is supported by the National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the (UK) National Health Service (NHS), the NIHR, or the (UK) Department of Health.

  • Competing interests PMM has received consulting/speaker’s fees from Abbvie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Roche and UCB; JEF has received grants and/or consulting/speaker’s fees from Abbvie, Ache, Bial, Biogen, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi and UCB; The other authors have declared no conflicts of interest.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data sets generated and/or analysed during the current study are not publicly available due to consent restrictions. Programming codes used for statistical analysis during the current study are available from the corresponding author upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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