MEASUREMENT OF SPINAL FUSION IN ANKYLOSING SPONDYLITIS

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。脊柱融合是强直性脊柱炎(AS)的临床、放射学和病理学特征。然而，在AS患者中，脊柱融合发生缓慢。连续X线片很少显示2年以上的变化，通常需要5年或更长时间才能显示脊柱融合的进展。需要对脊柱融合程度的变化比平片更敏感的方法来测试是否有任何治疗方法可以减缓或停止AS的脊柱融合。随着几种新药的问世，改善脊柱融合术的必要性变得更加迫切，这些药物有可能显着减少AS患者的脊柱炎症。这项先导性研究的目的是测试计算机断层扫描(CT)测量腰椎间盘纤维环的骨密度、骨体积或骨量是否能为AS患者的脊柱融合提供可靠、有效和敏感的测量方法。25名参与者将在基线、12个月和24个月进行腰椎CT扫描和脊柱X光检查，并在基线和12个月进行腰椎磁共振成像。此外，在为期24个月的研究期间，将每4个月进行一次临床评估。协议中没有提供任何治疗。在第一个研究年度内，不允许使用抗肿瘤坏死因子药物治疗，但对参与者可能接受的治疗没有其他限制。图像处理的可靠性将在基线扫描的重复测量中进行测试。结构效度将通过CT测量与平片、腰椎磁共振成像和脊柱活动范围评分的相关性来检验。12个月和24个月的CT测量对变化的敏感性将与基于平片的两种评分系统进行比较。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Spinal fusion is the clinical, radiological, and pathological hallmark of ankylosing spondylitis (AS). However, spinal fusion occurs slowly in AS. Serial radiographs rarely show changes over 2 years, and often 5 or more years are needed to demonstrate progression of spinal fusion. Methods that are more sensitive to changes in the extent of spinal fusion than plain radiographs are needed to test if any treatments can slow or halt spinal fusion in AS. The need for an improved measure of spinal fusion is heightened now that several new medications are available that have the potential to markedly decrease spinal inflammation in AS. The goal of this pilot study is to test whether measurement of bone mineral density, bone volume, or bone mass at the annulus fibrosis of lumbar disc spaces by computed tomography (CT) can provide a reliable, valid, and sensitive measure of spinal fusion in patients with AS. Twenty-five participants will have lumbar spine CT scans and spinal radiographs at baseline, 12 months, and 24 months, and lumbar spine magnetic resonance imaging at baseline and 12 months. In addition, clinical assessments will be done every 4 months during the 24-month study. No treatment is provided in the protocol. Treatment with anti-tumor necrosis factor medications is not permitted during the first study year, but there are no other restrictions on the treatments participants may receive. Reliability of image processing will be tested on repeated measurements of baseline scans. Construct validity will be tested by correlation of CT measures with scores of plain radiographs, lumbar magnetic resonance imaging, and spinal range of motion. The sensitivity to change of the CT measures over 12 months and 24 months will be compared to those of two scoring systems based on plain radiographs.