Reference: October 2025 | Issue 10 | Vol 11 | Page 5
Highlights from EULAR 2025
New research presented at the EULAR 2025 Congress aimed to increase the current limited knowledge regarding the predictors of long-term spinal radiographic progression in radiographic axial spondyloarthritis (r-axSpA).
High disease activity has previously been linked to accelerated radiographic spinal progression in patients with early axSpA, but more information is needed.
The data presented described a potential set of predictors for spinal progression, based on data collected from 176 patients with r-axSpA over a 13-year period. Patients fulfilling the modified New York criteria for r-axSpA (previously termed ankylosing spondylitis) were included in this longitudinal study. All participants examined at baseline, and again at five and 13 years. Spinal radiographs were graded according to the modified Stoke AS Spinal Score (mSASSS), and predictors for continuous change were assessed over various time periods.
Of the 176 patients included at baseline, 166 and 136 were assessed at the five- and 13-year follow-up timepoints, respectively, and 126 were assessed at all three timepoints. Over time, there was a significant increase in spinal ankylosis, with a mean increase of 1.6 points from baseline to five years, and 2.7 from five- to 13-year follow-up – reflecting a yearly average increase in mSASSS of 0.29 and 0.34, respectively. Sex-stratified analyses showed significant increases in both males and females.
Several factors were flagged as being significant associations when the researchers looked for predictors of progression. For example, higher C-reactive protein and being overweight or obese predicted progression in both sexes. Higher mSASSS at the start of follow-up and exposure to TNFi agents or bisphosphonates were associated with progression in females, whereas smoking and carrying the HLA-B27 gene were significant predictors in males.
Anna Deminger, lead author for the study, said: “On a group level, the progression in spinal pathological new bone formation was slow, but continued over 13 years in patients with long-standing r-axSpA.”
This study highlights the importance of inflammation as a negative prognostic marker for spinal radiographic progression. Other modifiable adverse prognostic markers were smoking and having a body mass index over 25. Of note, the higher risk of spinal radiographic progression in women exposed to TNFi or bisphosphonates needs to be further investigated.
