Detection of high cardiovascular risk patients with ankylosing spondylitis based on the assessment of abdominal aortic calcium as compared to carotid ultrasound.

BACKGROUND: This study aimed to determine whether, besides carotid ultrasound (US), a lateral lumbar spine radiography may also help identify ankylosing spondylitis (AS) patients at high risk of cardiovascular (CV) disease. METHODS: A set of 125 AS patients older than 35 years without a history of CV events, diabetes mellitus, or chronic kidney disease was recruited. Carotid US and lateral lumbar spine radiography were performed in all of them. The CV risk was calculated according to the total cholesterol systematic coronary risk evaluation (TC-SCORE) algorithm. Presence of carotid plaques was defined following the Mannheim Carotid Intima-media Thickness and Plaque Consensus. Abdominal aortic calcium (AAC) in a plain radiography was defined as calcific densities visible in an area parallel and anterior to the lumbar spine. RESULTS: Carotid US showed higher sensitivity than lateral lumbar spine radiography to detect high CV risk in the 54 patients with moderate TC-SCORE (61% versus 38.9%). Using carotid plaques as the gold standard test, a predictive model that included a TC-SCORE ≥ 5% or the presence of AAC in the lateral lumbar spine radiography in patients with both moderate and low CV risk (< 5%) according to the TC-SCORE yielded a sensitivity of 50.9% with a specificity of 95.7% to identify high/very high CV-risk AS patients. A positive correlation between AAC and carotid plaques was observed (r2 = 0.49, p < 0.001). CONCLUSIONS: A lateral lumbar spine radiography is a useful tool to identify patients with AS at high risk of CV disease.

Systematic assessment of inflammation by magnetic resonance imaging in the posterior elements of the spine in ankylosing spondylitis.

OBJECTIVE: Magnetic resonance imaging (MRI) is sensitive for scoring inflammatory lesions in the spine, but attention has primarily focused on vertebral bodies, and no study has systematically examined the posterior elements. We aimed to systematically determine the frequency and distribution of inflammatory changes in the posterior elements of the spine using MRI, and to assess the reliability of their detection and their impact on discrimination of spinal MRI. METHODS: We scanned 32 patients recruited to placebo-controlled trials of anti-tumor necrosis factor therapy. Inflammatory lesions were detected by systematic review of consecutive sagittal STIR slices of the entire spine. Two readers evaluated pretreatment and posttreatment scans, blinded to treatment and time point. Inflammation was scored dichotomously (present/absent) in each posterior structure. Reproducibility was assessed by calculating random model variance components and generalizability coefficients, and discrimination by using Guyatt's effect size. RESULTS: Most patients (87.5%) had > or =1 lesion in the posterior elements (mean +/- SD number of affected spinal levels per patient 6.7 +/- 5.3), and they were detected most frequently in the thoracic spine. Interobserver reproducibility for total lesion count was very good to excellent for lesions in the thoracic spine and transverse and spinous processes. The addition of a simple dichotomous method for scoring posterior element inflammation substantially enhanced the discrimination observed using established MRI methods for scoring vertebral body inflammation. CONCLUSION: Inflammatory lesions in the posterior elements were present in the majority of patients with AS, and standard MRI protocols of the spine should be modified to ensure adequate visualization of posterolateral structures.

Sulphasalazine in ankylosing spondylitis. A radiological, clinical and laboratory assessment.

In a 12-month double-blind placebo-controlled trial, the effect of sulphasalazine was studied in 40 patients with ankylosing spondylitis. The treatment group showed significant improvement in pain, stiffness, sleep disturbance (p less than 0.05), finger/floor distance, erythrocyte sedimentation rate, C-reactive protein, orosomucoid and IgA levels (p less than 0.01). There was improvement in sleep disturbance (p less than 0.05), finger/floor distance and erythrocyte sedimentation rate (p less than 0.01) in the placebo group. Sulphasalazine did not retard radiological progression as measured either by plain X-ray or computerised tomographic scans. Multiple analysis of variance did not show a significant difference in disease activity indicators between the 2 groups.

[The value of pyrophosphate scintigraphy for the assessment of the activity of spondylarthritis ankylopoietica (author's transl)]. / Der Wert der Pyrophosphat-Szintigraphie für die Beurteilung der Aktivität der Spondylarthritis ankylopoetica

Seriological and scintigraphic activity was compared in 29 patients with spondylarthritis ankylopoietica (Bechterew's disease). Among our cases, 11 serologically active patients also had positive scans. the details being: cervical vertebral column in 5, thoracic vertebral column in 7 cases and the lumbar vertebral column and iliosacral joint in all 11 patients. In the group of 16 serologically inactive patients, 12 cases could be confirmed radiologically, in the remaining 4 early detection of ankylosing spondylarthritis was possible from the scintigraphic findings in combination with the clinical symptoms. The clinically suspected diagnosis of an incipient Bechterew's disease could not be justified in the remaining 2 patients who had no positive scintigraphic or serological results.