New Study Identifies Key Risk Factors for Spinal Deterioration in r-axSpA Patients

Recent research presented at the 2025 annual congress of the European Alliance of Associations for Rheumatology (EULAR) in Barcelona highlights significant predictors of spinal deterioration in patients diagnosed with radiographic axial spondyloarthritis (r-axSpA). This chronic inflammatory condition primarily impacts the axial skeleton and is classified based on the presence of radiographic sacroiliitis.

The study, which gathered data over a span of 13 years from 176 patients meeting the modified New York criteria for r-axSpA, aimed to identify factors influencing spinal progression. Participants underwent evaluations at baseline, and again at five and thirteen years. Their spinal radiographs were assessed using the modified Stoke AS Spinal Score (mSASSS), enabling researchers to track changes in spinal health over time.

Of the initial group, 166 patients were evaluated at the five-year mark, and 136 at the thirteen-year follow-up, with 126 individuals participating in all three assessments. Findings revealed a notable increase in spinal ankylosis, with an average mSASSS score increase of 1.6 points from baseline to five years, and an additional 2.7 points from five to thirteen years. This corresponds to yearly average increases of 0.29 and 0.34 points, respectively, with similar patterns observed in both male and female participants.

The researchers identified several key factors associated with spinal progression. Notably, elevated C-reactive protein levels and higher body mass index (BMI) were significant predictors for both genders. Additionally, higher mSASSS scores at the outset of follow-up were linked to progression in females, as were treatments involving tumor necrosis factor inhibitors (TNFi) and bisphosphonates. In contrast, for males, smoking habits and the presence of the HLA-B27 gene emerged as critical predictors.

Lead researcher Anna Deminger emphasized that, while the overall progression of spinal pathological new bone formation was gradual, it persisted over the 13-year study duration in patients with long-standing r-axSpA. This underscores the detrimental role of inflammation as a prognostic marker for spinal radiographic progression. Modifiable risk factors such as smoking and BMI over 25 also warrant attention. The heightened risk of spinal deterioration among women receiving TNFi or bisphosphonates necessitates further investigation.

As the understanding of r-axSpA evolves, this study contributes valuable insights into the factors influencing spinal health in affected individuals, paving the way for potential targeted interventions and improved patient outcomes.