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Relevance of osteoproliferation as an outcome parameter in ankylosing spondylitis

Nature Clinical Practice Rheumatology volume 4, pages 578–579 (2008)Cite this article

Ankylosing spondylitis (AS) has a prevalence of around 0.5% in the general population and affects more males than females.1 Disease onset generally occurs in the second decade of life, and in 90% of patients is first seen in the sacroiliac joint.1 Further on in the course of the disease, the whole spine can be affected with spondylitis, spondylodiscitis and arthritis of the small intervertebral joints. Subsequent to inflammation, new bone formation occurs via the development of syndesmophytes, which is regarded as the hallmark of the disease. Although it is unclear whether ankylosis of the sacroiliac joints has any functional relevance, the formation of syndesmophytes between vertebral bodies and the ossification of the zygapophyseal joints is generally regarded as a major determinant for long-term outcome and disability. Not all AS patients, however, have or develop syndesmophytes; in an AS cohort, with symptom duration less than 10 years, syndesmophytes were found in about 25% of patients,2 which increased to about 50%3 in patients with more-advanced disease.

The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) is currently the most frequently used scoring method for radiographic progression of the spine.4 It scores the anterior sites of the lumbar and cervical spine on a lateral view. All four corners of each vertebra are scored in the following way: 1 for erosion, sclerosis and/or squaring; 2 for a syndesmophyte; and 3 for total bony bridging at each site. The maximum possible score is 72. At a cohort level, a notable change in this score does not occur before 2 years after symptom onset, but individual patients might progress more rapidly. Mean increases in this score of between 0.4 and 1.5 have been reported in several AS cohorts, with and without therapeutic intervention, over an observation period of 2 years.3,5,6

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Authors and Affiliations

  1. H Appel and M Rudwaleit are both Consultants and Lecturers in the Department of Medicine at the Charité Hospital Benjamin Franklin and J Sieper is Head of Rheumatology at the Campus Benjamin Franklin of the Charité University Hospital in Berlin, Germany.,

    Heiner Appel, Martin Rudwaleit & Joachim Sieper

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  1. Heiner Appel
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  2. Martin Rudwaleit
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Correspondence to Joachim Sieper.

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Competing interests

H Appel has received grant support from Centocor. M Rudwaleit has received consultant fees, speakers' bureau honoraria and grant support from Abbott, Schering-Plough and Wyeth, in addition to speakers' bureau honoraria and grant support from Pfizer. J Sieper has received consultant fees, speakers' bureau honoraria and grant support from Abbott, Schering-Plough and Wyeth, in addition to speakers' bureau honoraria and grant support from Pfizer.

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Appel, H., Rudwaleit, M. & Sieper, J. Relevance of osteoproliferation as an outcome parameter in ankylosing spondylitis. Nat Rev Rheumatol 4, 578–579 (2008). https://doi.org/10.1038/ncprheum0930

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