Abstract
Background: Spondyloarthritis represents a group of several inflammatory conditions. Ankylosing spondylitis and nr-axSpA are considered to belong to spondyloarthritis family of diseases.
Aim of the work: to evaluate bone mineral density (BMD) and trabecular bone scores(TBS) scores in patients suffering from non-radiographic axial spondyloarthritis (nr-axSpA).
Materials and Methods: A cross-sectional study evaluating 160 patients. Inclusion criteria involved patients 18-45 years of age, having clinical features of spondyloarthritis, and fulfilling Calin’s criteria for inflammatory low back pain. Patients were divided into 3 groups; group A (nr-axSpA) patients, group B (radiographic axial spondyloarthritis (r-axSpA)) patients, and group C (mechanical low back pain).
Results: Female to male ratio was significantly higher in group A compared to group B (63.3% vs. 36.7%) and (23.33% vs. 76.7%) (p< 0.001), respectively. While disease duration was significantly higher in group B in comparison to groups A and C (47.65±7.15, 18.56±6.55, and 14.76±4.20) (p<0.001), respectively. L1-L4 and L2-L4 TBS of groups A and B were significantly lower compared to group C (p<0.001). Additionally, a statistically significant decrease in BMD scores of L1-L4, femoral neck, and total hip bones was detected in group A compared to group C (p< 0.001).
Conclusion: Patients with nr-axSpA had a lower BMD and TBS compared to r-axSpA group (B) and control group (C), and it predominantly affected more females than males (3:1).
Keywords: Spondyloarthritis, nr-axSpA, r-axSpA, BMD, TBS, Egypt.
References
- Ghosh N, Ruderman EM. Nonradiographic axial spondyloarthritis: clinical and therapeutic relevance. Arthritis Res Ther. 2017;19(1):286.
- Poddubnyy D. Axial spondyloarthritis: is there a treatment of choice?. Ther Adv Musculoskelet Dis. 2013;5(1):45-54.
- Wang R, Ward MM. Epidemiology of axial spondyloarthritis: an update. Curr Opin Rheumatol. 2018;30(2):137-143.
- Kim HR, Hong YS, Park SH, Ju JH, Kang KY. Low bone mineral density predicts the formation of new syndesmophytes in patients with axial spondyloarthritis. Arthritis Res Ther. 2018;20(1):231.
- Schett G. Structural bone changes in spondyloarthritis: mechanisms, clinical impact and therapeutic considerations. Am J Med Sci. 2011;341(4):269-271.
- Briot K, Roux C. Inflammation, bone loss and fracture risk in spondyloarthritis. RMD Open. 2015;1(1):e000052.
- Hans D, Barthe N, Boutroy S, Pothuaud L, Winzenrieth R, Krieg MA. Correlations between trabecular bone score, measured using anteroposterior dual-energy X-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae. J Clin Densitom. 2011;14(3):302-312.
- Maksymowych W, Inman R, Salonen D, Dhillon S, Williams M, Stone M, Conner-spady B, Palsat J. and Lambert R. Spondyloarthritis research Consortium of Canada magnetic resonance imaging index for assessment of sacroiliac joint inflammation in ankylosing spondylitis. Arthritis Rheum. 2005;53(5):703-709.
- Bray T, Jones A, Bennett A, Conaghan P, Grainger A, Hodgson R, Hutchinson C, Leandro M, Mandl P, McGonagle D, O’Connor P, Sengupta R, Thomas M, Toms A, Winn N, Hall-Craggs M, Marzo-Ortega H. and Machado P. Recommendations for acquisition and interpretation of MRI of the spine and sacroiliac joints in the diagnosis of axial spondyloarthritis in the UK Rheumatology (Oxford). 2019;58(10):1831-1838.
- Lukas C, Braun J, van der Heijde D, Hermann KG, Rudwaleit M, Østergaard M, Oostveen A, O'Connor P, Maksymowych WP, Lambert RG, Jurik AG, Baraliakos X, Landewé R; ASAS/ OMERACT MRI in AS Working Group. Scoring inflammatory activity of the spine by magnetic resonance imaging in ankylosing spondylitis: a multireader experiment. J Rheumatol. 2007;34(4):862-870.
- van der Heijde D, Landewé R, Hermann KG, Rudwaleit M, Østergaard M, Oostveen A, O'Connor P, Maksymowych WP, Lambert RG, Lukas C, Jurik AG, Boers M, Baraliakos X, Braun J; ASAS/OMERACT MRI in AS Working Group. Is there a preferred method for scoring activity of the spine by magnetic resonance imaging in ankylosing spondylitis?. J Rheumatol. 2007;34 (4):871-873.
- McCloskey EV, Odén A, Harvey NC, Leslie WD, Hans D, Johansson H, Barkmann R, Boutroy S, Brown J, Chapurlat R, Elders PJM, Fujita Y, Glüer CC, Goltzman D, Iki M, Karlsson M, Kindmark A, Kotowicz M, Kurumatani N, Kwok T, Lamy O, Leung J, Lippuner K, Ljunggren Ö, Lorentzon M, Mellström D, Merlijn T, Oei L, Ohlsson C, Pasco JA, Rivadeneira F, Rosengren B, Sornay-Rendu E, Szulc P, Tamaki J, Kanis JA. A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX. J Bone Miner Res. 2016;31(5):940-948.
- Boutroy S, Hans D, Sornay-Rendu E, Vilayphiou N, Winzenrieth R, Chapurlat R. Trabecular bone score improves fracture risk prediction in non-osteoporotic women: the OFELY study. Osteoporos Int. 2013;24(1):77-85.
- Kiltz U, Baraliakos X, Karakostas P, Igelmann M, Kalthoff L, Klink C, Krause D, Schmitz-Bortz E, Flörecke M, Bollow M, Braun J. Do patients with non-radiographic axial spondylarthritis differ from patients with ankylosing spondylitis?. Arthritis Care Res (Hoboken). 2012;64(9):1415-1422.
- Rusman T, van Vollenhoven RF, van der Horst-Bruinsma IE. Gender Differences in Axial Spondyloarthritis: Women Are Not So Lucky. Curr Rheumatol Rep. 2018;20(6):35.
- Benchérifa S, Amine B, El Binoune I, Hmamouchi I, Rostom S, Abouqal R, Achemlal L, Allali F, El Bouchti I, El Maghraoui A, Ghozlani I, Hassikou H, Harzy T, Ichchou L, Mkinsi O, Niamane R, Bahiri R. Radiographic axial versus nonradiographic axial spondyloarthritis: Comparison of the disease activity parameters and the disease activity and functional scores: RBSMR study. Int J ClinRheumtol. 2019;14(6):282-287.
- Bubová K, Forejtová Š, Zegzulková K, Gregová M, Hušáková M, Filková M, Hořínková J, Gatterová J, Tomčík M, Szczuková L, Pavelka K, Šenolt L. Cross-sectional study of patients with axial spondyloarthritis fulfilling imaging arm of ASAS classification criteria: baseline clinical characteristics and subset differences in a single-centre cohort. BMJ Open. 2019;9(4):e024713.
- Wallman JK, Kapetanovic MC, Petersson IF, Geborek P, Kristensen LE. Comparison of non-radiographic axial spondyloarthritis and ankylosing spondylitis patients--baseline characteristics, treatment adherence, and development of clinical variables during three years of anti-TNF therapy in clinical practice. Arthritis Res Ther. 2015;17:378.
- Lorenzin M, Ometto F, Ortolan A, Felicetti M, Favero M, Doria A, Ramonda R. An update on serum biomarkers to assess axial spondyloarthritis and to guide treatment decision. TherAdvMusculoskelet Dis. 2020;12:1759720X20934277.
- Micheroli R, Hebeisen M, Wildi LM, Exer P, Tamborrini G, Bernhard J, Möller B, Zufferey P, Nissen M, Scherer A, Ciurea A. Impact of obesity on the response to tumor necrosis factor inhibitors in axial spondyloarthritis. Arthritis Res Ther. 2017;19(1):164.
- Akgöl G, Kamanlı A, Ozgocmen S. Evidence for inflammation-induced bone loss in non-radiographic axial spondyloarthritis. Rheumatology (Oxford). 2014;53(3):497-501.
- Caparbo VF, Furlam P, Saad CGS, Alvarenga JC, Aubry-Rozier B, Hans D, de Brum-Fernandes AJ, Pereira RMR. Assessing bone impairment in ankylosing spondylitis (AS) using the trabecular bone score (TBS) and high-resolution peripheral quantitative computed tomography (HR-pQCT). Bone. 2019;122:8-13.
- Rajaei A, Amiri A, Farsad F, Dehghan P. The Correlation between Trabecular Bone Score and Lumbar Spine Bone Mineral Density in Patients with Normal and High Body Mass Iran J Med Sci. 2019;44(5):374-381.
Corresponding Author
Prof. Hesham Hamoud
Rheumatology Department, Al-Azhar University, Nasr City, Cairo, Egypt
DOI: https://dx.doi.org/10.18535/jmscr/v8i11.84
