Development of a Radiographic Scoring Tool for Ankylosing Spondylitis Only Based on Bone Formation: Addition of the Thoracic Spine Improves Sensitivity to Change
Development of a Radiographic Scoring Tool for Ankylosing Spondylitis Only Based on Bone Formation: Addition of the Thoracic Spine Improves Sensitivity to Change
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DOI：
10.1002/art.24425
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发表时间：
2009-06-15
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影响因子：
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通讯作者：
Braun, J.
中科院分区：
文献类型：
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作者：
Baraliakos, X.;Listing, J.;Braun, J.
目标。改良的斯托克斯强直性脊柱炎脊柱评分(MSASSS)量化了颈椎(C-脊柱)和腰椎(L脊柱)的X线改变，但不包括胸椎(T-脊柱)。我们的目的是研究强直性脊柱炎(AS)患者T脊椎下部在结构损伤中的作用。两名读者使用mSASSS对80例AS患者在基线时和两年后的X线片进行评分。此外，对下T-脊柱(T10-T12)的变化进行了量化。在此基础上，开发了一种新的评分工具：放射学强直性脊柱炎脊柱评分(RASSS)。RASSS包括两个变化：由于解剖学和可行性的原因，不对侵蚀进行评分以限制新骨的形成，以及不对C-脊柱的平方进行评分。使用mSASSS的平均+/-SD变化为0.9%+/-2.5单位，使用RASSS的平均+/-2.8单位(P<；0.001)。尽管mSASSS在两年多的时间里在平均+/-SD 1.4+/-2.9椎体边缘发现了新的椎间突起，但在下T脊椎中又发现了0.6+/-1.2椎体边缘。C-脊柱/L脊柱有15例(21.4%；95%可信区间[95%CI]13.1-32.4%)，T-脊柱有6例(8.6%；95%可信区间3.8-17.2%)发现新的关节突起或关节僵硬。RASSS的信度和读者之间的一致性都很好。下T形脊柱可提高AS患者对评分变化的敏感性。在这项研究中开发的工具，RASSS，显示出比mSASSS更好的表面和内容有效性，并被证明在AS新骨形成的量化方面更好。
Objective. The modified Stokes Ankylosing Spondylitis Spinal Score (mSASSS) quantifies radiographic changes in the cervical spine (C-spine) and the lumbar spine (L-spine), but not in the thoracic spine (T-spine). Our objective was to study the contribution of the lower part of the T-spine to structural damage in patients with ankylosing spondylitis (AS).Methods. Radiographs of 80 AS patients obtained at baseline and after 2 years were scored by 2 readers using the mSASSS. In addition, changes in the lower T-spine (T10-T12) were quantified. On this basis, a new scoring tool was developed: the Radiographic Ankylosing Spondylitis Spinal Score (RASSS). The RASSS includes 2 changes: no scoring of erosions in order to confine the scoring to new bone formation, and no scoring of squaring in the C-spine for anatomic and feasibility reasons.Results. The mean +/- SD change was 0.9 +/- 2.5 units using the mSASSS and 1.6 +/- 2.8 units using the RASSS (P < 0.001). Although the mSASSS identified new syndesmophytes in mean +/- SD 1.4 +/- 2.9 vertebral edges over 2 years, an additional 0.6 +/- 1.2 vertebral edges were seen in the lower T-spine. New syndesmophytes or ankylosis were found in 15 patients (21.4%; 95% confidence interval [95% CI] 13.1-32.4%) in the C-spine/L-spine and in 6 patients (8.6%; 95% CI 3.8-17.2%) in the T-spine alone. The reliability of the RASSS and the agreement between readers was excellent.Conclusion. The lower T-spine improves the sensitivity to change of scoring radiographic progression in AS. The tool developed in this study, the RASSS, showed better face and content validity than the mSASSS and was proven to be superior in the quantification of new bone formation in AS.