HLA-B27 +/LBP/Normal Imaging

Only 26% progress to AS. Holster your opioids...

Arthritis Rheumatol. 2015 Dec 14. doi: 10.1002/art.39542. [Epub ahead of print]
Progression of Patients with Non-Radiographic Axial Spondyloarthritis to Ankylosing Spondylitis: A Population-Based Cohort Study.
Wang R1, Gabriel SE2,3, Ward MM1.
Author information

Abstract
OBJECTIVE:
The long-term outcome of patients with non-radiographic axial spondyloarthritis (nr-axSpA) is unclear, particularly whether few or most progress to ankylosing spondylitis (AS). Our objective was to examine the progression to AS in a population-based inception cohort of patients with nr-axSpA.

METHODS:
The Rochester Epidemiology Project (REP) is a longstanding population-based study of health in the residents of Olmsted County, Minnesota. We searched the REP from 1985 to 2010 using diagnostic and procedural codes for back pain, HLA-B27 and pelvis magnetic resonance imaging, and performed detailed chart review to identify subjects who fulfilled the Assessment of Spondyloarthritis International Society classification criteria for axSpA but did not have AS. We followed these subjects from disease onset to March 15th , 2015, and used survival analysis to measure time to progression to AS.

RESULTS:
After screening 2151 patients, we identified 83 subjects with new-onset nr-axSpA. Over a mean follow-up of 10.6 years, 16 subjects progressed to AS. The probabilities of remaining as nr-axSpA at 5, 10, and 15 years were 93.6%, 82.7%, and 73.6%, respectively. Subjects in the imaging arm (n=18) progressed more frequently and rapidly than those in the clinical arm (n=65) (28% versus 17%; hazard ratio 3.50, 95% CI 1.15-10.6, p=0.02).

CONCLUSIONS:
A minority (26%) of patients with nr-axSpA progressed to AS when followed for up to 15 years. This suggests that the classification criteria for nr-axSpA identifies many patients unlikely to progress to AS, or that nr-axSpA is a prolonged prodromal state, requiring longer follow-up to evolve to AS. This article is protected by copyright. All rights reserved.

© 2015, American College of Rheumatology.

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HLA-B27 +/LBP/Normal Imaging