Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system

OBJECTIVE To develop and validate an extensive radiographic scoring system for ankylosing spondylitis (AS). METHODS The Stoke Ankylosing Spondylitis Spinal Score (SASSS) was modified by adding a score for the cervical spine and defining squaring. This modified SASSS (mSASSS) is the sum of the lumbar and cervical spine score (range 0-72). 370 lateral views of the lumbar and cervical spine were used for development of the mSASSS, standardisation of observers, and for studying reliability. In a 48 week NSAID study of 57 patients, change over time and construct validity were studied. RESULTS Interobserver correlations of the lumbar and cervical spine scores were good (r>0.95). The interobserver duplicate error was 0.55 in a range from 0 to 36. The mean change in the cervical and lumbar spine scores between weeks 0 and 48 of all patients was 1.45 (range 0-6.0) and 1.06 (0-5.0), respectively (paired t testing, p<0.001). Change in radiological score was seen in 36/57 (63%) patients (lumbar and cervical spine 11, cervical spine 12, lumbar spine 13 patients). CONCLUSION The mSASSS is useful for assessing extensive radiographic damage in AS. It is reliable, detects changes over 48 weeks, and shows a satisfactory face and construct validity.

[1]  J. Rubenstein,et al.  The natural disease course of ankylosing spondylitis. , 1983, Arthritis and rheumatism.

[2]  S. Ralston,et al.  A new method for the radiological assessment of vertebral squaring in ankylosing spondylitis. , 1992, Annals of the rheumatic diseases.

[3]  A. Cats,et al.  Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. , 1984, Arthritis and rheumatism.

[4]  M. A. van 't Hof,et al.  A Dutch version of the functional index for ankylosing spondylitis: development and validation in a long-term study. , 1994, British Journal of Rheumatology.

[5]  A. Calin,et al.  The Bath Ankylosing Spondylitis Radiology Index (BASRI): a new, validated approach to disease assessment. , 1998, Arthritis and rheumatism.

[6]  J. Simpson,et al.  Studies with an enthesis index as a method of clinical assessment in ankylosing spondylitis. , 1987, Annals of the rheumatic diseases.

[7]  H. Zeidler,et al.  Long-term efficacy and safety of infliximab in the treatment of ankylosing spondylitis: an open, observational, extension study of a three-month, randomized, placebo-controlled trial. , 2003, Arthritis and rheumatism.

[8]  J. Korst,et al.  Assessment Of The Flexibility Of The Lumbar Spine: A Pilot Study in Children and Adolescents , 1973 .

[9]  P. Dawes,et al.  The relationship of clinical and laboratory measurements to radiological change in ankylosing spondylitis. , 1991, British journal of rheumatology.

[10]  J. Braun,et al.  Six-month results of a double-blind, placebo-controlled trial of etanercept treatment in patients with active ankylosing spondylitis. , 2003, Arthritis and rheumatism.

[11]  M. A. van 't Hof,et al.  Disease activity in ankylosing spondylitis: selection of a core set of variables and a first set in the development of a disease activity score. , 1996, British journal of rheumatology.

[12]  Kunkel Jm,et al.  Spontaneous subclavain vein thrombosis: a successful combined approach of local thrombolytic therapy followed by first rib resection. , 1989 .