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Jung, Lee, Choe, Park, Kim, Kim, Kim, Han, and Kim: Determining Clinical Risk Factors for Radiographical Severity in Patients with Ankylosing Spondylitis in Daegu and Kyungpook Territories
Original Article

J Korean Rheum Assoc 2010;17(4):376-385.

Published online: 23 December 2010

DOI: https://doi.org/10.4078/jkra.2010.17.4.376

Determining Clinical Risk Factors for Radiographical Severity in Patients with Ankylosing Spondylitis in Daegu and Kyungpook Territories

Hyun-Young Jung1, Hwa Jeong Lee1, Jung-Yoon Choe1, Sung-Hoon Park1, Seong-Kyu Kim1, Sang-Hyon Kim2, Juyoun Kim2, Seung Woo Han3, Seong-Ho Kim4

1Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Busan, Korea

2Department of Internal Medicine, School of Medicine, Keimyung University, Busan, Korea

3Division of Rheumatology, Department of Internal Medicine, Daegu Fatima Hospital, Busan, Korea

4Daegu, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea

Received 26 August 20108 September 2010       Accepted 8 October 2010

Copyright © 2010 The Korean Rheumatism Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

This study was designed to identify prognostic determinants of radiographical severity in patients with ankylosing spondylitis (AS) living in Daegu and Kyungpook territories.

Methods

One hundred-nineteen patients with AS were consecutively enrolled from four regional general hospitals. Clinical data including smoking habits, alcohol intake, disease duration, HLA-B27 positivity, involvement of peripheral joints, occupational activity, and regular exercise were investigated. Radiographical severity was assessed by the Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Statistical analyses were performed using the independent Student's t-test, Pearson's correlation coefficient analysis, and multivariate regression analysis.

Results

Radiographical severity, as evaluated with the mSASSS, was associated with age of disease onset (p=0.011) and disease duration (p<0.001). Additionally, mSASSS was significantly higher in males than females (p=0.039) and in patients without involvement of ankle arthritis than those with involvement of ankle arthritis (p=0.026). Patients with hip arthritis had significantly higher mSASSS scores than those without hip arthritis. A multivariate regression analysis showed that older age of disease onset, male gender, and disease duration were independent predictors of AS radiographical severity (p<0.001, p=0.013, and p<0.001, respectively). Hip arthritis was an independent predictor of C-spine radiographical severity in AS (p=0.031).

Conclusion

Radiographical severity of the prognosis was determined by age of disease onset, gender, and disease duration in patients with AS living in Daegu and Kyungpook territories.

Keywords: Ankylosing spondylitis, Age, Gender, Peripheral arthritis, mSASSS

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Fig. 1.
Association of the Modified Stoke Ankylosing Spondylitis Spinal Score as a radiographical severity index with age of disease onset and disease duration. (A) An older age at onset in patients with ankylosing spondylitis was associated with more advanced radiological damages (R=0.233, p=0.011). (B) More advanced radiographical progression was closely associated with disease duration (R=0.382, p<0.001).
jkra-17-376f1.tif
Table 1.
General characteristics of ankylosing spondylitis (n=119)
Characteristics Values
Age (year) 40.6±11.0
Sex, female (n, %) 20 (16.8)
Weight (kg) 66.6±9.9
Height (cm) 168.9±7.7
Onset age of disease (year) 27.4±9.7
Disease duration (year) 13.2±8.8
Smoking
Non-smoker 31 (21.6)
Current smoker 47 (39.5)
Former smoker 41 (34.5)
Marital status, married 86 (72.3)
Occupational activity
Mild 76 (63.9)
Moderate 32 (26.9)
Severe 11 (9.2)
Alcohol intake
Non-alcoholics 40 (33.6)
Current alcoholics 50 (42.0)
Former alcoholics 29 (24.4)
Family history (n=117) 16 (13.7)
Regular exercise
None/week 62 (52.1)
1~2 times/week 29 (24.4)
≥3 times/week 28 (23.5)
HLA-B27 positivity (n=87) 78 (89.7)
Non-spinal arthritis
Peripheral arthritis∗ 66 (55.5)
Knee 57 (47.9)
Ankle 38 (31.9)
Hip 44 (37.0)
Shoulder 65 (54.6)
Uveitis
None 82 (68.9)
Unilateral 19 (16.0)
Bilateral 18 (15.1)
Enthesitis 22 (18.5)
Inflammatory bowel disease 26 (21.8)

∗Peripheral arthritis included arthritis involving the knee and ankle joints

Table 2.
Comparison of mSASSS scores according to presence of clinical features
Total mSASSS mSASSS of C-spine mSASSS of L-spine
Mean±SD p-value Mean±SD p-value Mean±SD p-value
Sex
Male 29.90±21.66 13.54±12.30 16.36±12.38
Female 19.55±19.07 0.039 8.40±10.24 0.083 8.40±10.24 0.046
Smoking
Non-current smoker 25.90±20.06 11.65±10.33 14.25±12.29
Current smoker 31.62±23.40 0.158 14.23±14.35 0.290 17.38±11.67 0.168
Alcohol
Non-current alcoholic 26.62±20.36 11.46±12.02 15.16±11.71
Current alcoholic 30.28±23.08 0.363 14.34±12.11 0.201 15.94±12.72 0.730
HLA-B27
Positive 28.19±20.99 12.74±12.03 15.45±12.08
Negative 34.44±26.82 0.413 16.22±14.26 0.422 18.22±13.91 0.522
Peripheral arthritis
Yes 24.65±18.08 10.65±9.74 14.00±11.40
No 32.53±24.66 0.055 15.19±14.19 0.051 17.34±12.78 0.140
Knee arthritis
Yes 24.56±18.24 11.02±10.08 13.54±11.14
No 31.47±23.83 0.077 14.19±13.59 0.153 17.27±12.75 0.091
Ankle arthritis
Yes 22.32±17.38 9.11±9.11 13.21±11.72
No 30.90±22.80 0.026 14.35±12.97 0.013 16.56±12.20 0.161
Hip arthritis
Yes 36.43±24.73 17.77±14.79 18.66±12.54
No 23.31±17.86 0.003 9.68±9.02 0.002 13.63±11.51 0.028
Shoulder arthritis
Yes 25.85±20.01 11.17±10.85 14.68±11.77
No 30.94±23.11 0.200 14.48±13.31 0.137 16.46±12.53 0.425
Uveitis
Yes 29.21±25.52 13.95±13.64 15.26±13.54
No 28.49±21.25 0.898 12.61±11.95 0.670 15.88±12.12 0.846
Enthesitis
Yes 23.23±18.60 9.36±9.24 13.86±11.78
No 29.28±22.07 0.235 13.42±12.57 0.156 15.86±12.20 0.488

mSASSS: Modified Stoke Ankylosing Spondylitis Spinal Score

Table 3.
Multivariate regression analysis for radiographical severity
Dependent variables
Total mSASSS (R=0.625) mSASSS of C-spine (R=0.542) mSASSS of L-spine (R=0.584)
Clinical parameters B (95% CI for B) p-value B (95% CI for B) p-value B (95% CI for B) p-value
Onset age of disease 0.915 (0.565, 1.265) < 0.001 0.428 (0.217, 0.640) < 0.001 0.483 (0.278, 0.688) < 0.001
Sex (male) 10.798 (2.410, 19.185) 0.012 5.388 (0.326, 10.449) 0.037 5.439 (0.535, 10.344) 0.030
Disease duration 1.168 (0.792, 1.545) < 0.001 0.483 (0.256, 0.710) < 0.001 0.690 (0.470, 0.910) < 0.001
Hip arthritis 6.163 (–0.846, 13.172) 0.084 5.518 (1.468, 9.569) 0.031 1.964 (–1.949, 5.877) 0.322
Ankle arthritis –4.430 (11.445, 2.584) 0.213 –2.828 (–7.061, 1.405) 0.188

mSASSS: Modified Stoke Ankylosing Spondylitis Spinal Score

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