Early spondyloarthritis: vertebral fractures uncommon in 5-year DESIR study

  • Sahuguet J & al.
  • Ann Rheum Dis
  • 2 Nov 2018

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Patients with early spondyloarthritis (SpA) prospectively studied over the course of 5 years have a low incidence (1.16%) and prevalence (3.0%) of vertebral fractures (VFs), almost all of which are located in the thoracic spine.

Why this matters

  • Prevalence was lower than previously reported (4%-42%).

Study design

  • Prospective cohort of patients with inflammatory back pain highly suggestive of axial SpA (n=432) in DESIR (Devenir des Spondylarthropathies Indifferenciees Recentes).
  • VF diagnosis was made by the interpretation of radiographs (at baseline and 5 years), using Genant's method, applied by a single specialized radiologist.
  • VF grading scale ranged from 0 (normal) to 3 (severe fracture with a ≥40% decrease in the vertebral body height).
  • Funding: None.

Key results

  • Mean age of patients was 34.3±8.7 years, 53% were women, and 14% had low bone mineral density (Z-score ≤−2 at ≥1 site).
  • Prevalence of VFs was 3.0%; all located at thoracic spine, almost all grade 1.
  • Incidence of VFs over 5 years of observation was 1.16% (5/432) in 7 vertebrae, with 6/7 in the thoracic spine; 6/7 were grade 1.
  • Incidence of vertebral deformities (VDs) over 5 years was 2.3%, all located in thoracic spine.
    • The most common VDs were degenerative changes (discarthrosis, increase in kyphosis) and structural changes (squaring, discitis).

Limitations

  • None identified.

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