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  • No relationship between bone mineral density and syndesmophyte formation at the same level in the lumbar spine of patients with radiographic axial Spondyloarthritis

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Spondyloarthritis
Original research
No relationship between bone mineral density and syndesmophyte formation at the same level in the lumbar spine of patients with radiographic axial Spondyloarthritis
  1. Mary Lucy Marques1,2,
  2. Sofia Ramiro1,3,
  3. Pedro M Machado4,5,6,
  4. Desirée van der Heijde1 and
  5. Floris A van Gaalen1
  1. 1 Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, Netherlands
  2. 2 Department of Rheumatology, Centro Hospitalar E Universitario De Coimbra EPE, Coimbra, Portugal
  3. 3 Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
  4. 4 Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK
  5. 5 Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
  6. 6 Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
  1. Correspondence to Mary Lucy Marques; mary.lucy.marques{at}gmail.com

Abstract

Objective To investigate if in radiographic axial Spondyloarthritis (r-axSpA) low vertebral bone mineral density (BMD) is associated with development of new syndesmophytes at the same vertebral level.

Methods In a post-hoc analysis from the ASSERT trial (infliximab vs placebo), dual-energy X-ray absorptiometry was used to measure baseline BMD (g/cm2) of the lumbar spine L1 to L4. Syndesmophyte formation was assessed in the same vertebrae on conventional radiographs defined as an increase in modified Stoke Ankylosing Spondylitis Spine Score from 0 or 1 to 2 or 3 after 2 years. Radiographs were scored by two readers. Generalised estimating equations (GEE) adjusted for within-patient correlation across multiple vertebrae, taking potential confounders into account.

Results We analysed 599 vertebrae in 165 r-axSpA patients (78% male, mean (SD) age 38 (10) years, 67% with at least one syndesmophyte anywhere in the spine). In total, 24 to 74 new syndesmophytes developed in 9 (5%) to 30 (18%) patients and 13 (2%) to 39 (7%) vertebrae, if either a syndesmophyte was seen by both or only one of the readers (ie, specific and sensitive definitions) respectively. In multivariable analyses, no association was found between baseline local vertebral BMD and new syndesmophyte formation after 2 years: adjOR (95% CI): 0.56 (0.01, 44.45) (specific definition) and 0.26 (0.03, 2.63) (sensitive definition).

Conclusion In patients with active and established r-axSpA, with an observed low incidence of lumbar spine syndesmophyte formation over 2 years, no relationship was found between baseline BMD and new radiographic syndesmophyte formation at the same vertebra.

  • Spondylitis
  • Ankylosing
  • Bone Density
  • Inflammation
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rmdopen-2020-001391

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    Footnotes

    • Twitter Pedro M Machado @pedrommcmachado.

    • Acknowledgements This study, carried out under YODA Project #2018-2761, used data obtained from the Yale University Open Data Access Project, which has an agreement with Janssen Research & Development, LLC. The interpretation and reporting of research using these data are solely the responsibility of the authors and does not necessarily represent the official views of the Yale University Open Data Access Project or Janssen Research & Development, LLC. The work on this manuscript was previously accepted to the ACR Convergence 2020 and published as a conference abstract in the correspondent supplement of Arthritis & Rheumatology.

    • Contributors MLM, SR, DvdH and FvG designed the study. MLM developed the protocol to request the ASSERT cohort data from the Yale University Open Data Access Project. PMM provided the MRI scoring data. MLM and SR analysed the data. MLM prepared the first version of the manuscript. DvdH, SR and FvG supervised and contributed to all steps of the work. All authors critically interpreted the results, reviewed the draft versions and gave their approval of the final version of the 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. PMM 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 author and not necessarily those of the (UK) National Health Service (NHS), the NIHR, or the (UK) Department of Health. MLM is supported by the Fundação para a Ciência e Tecnologia (FCT) grant SFRH/BD/143744/2019.

    • Competing interests None declared.

    • Patient consent for publication Not required.

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

    • Data availability statement Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplemental information.