New Study Identifies Key Factors Influencing Spinal Deterioration in Radiographic Axial Spondyloarthritis (r-axSpA)

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic condition primarily affecting the axial skeleton, including the spine and sacroiliac joints. This umbrella term encompasses both patients with radiographic evidence of sacroiliitis (r-axSpA) and those without, with recent guidelines published in 2022 to better classify and manage these patients.

Recent research presented at the 2025 European Congress of Rheumatology in Barcelona sheds light on the factors that contribute to spinal deterioration in patients with r-axSpA. The study involved a comprehensive longitudinal analysis over 13 years, including 176 patients who met the modified New York criteria for r-axSpA (previously known as ankylosing spondylitis). Participants were examined at baseline, then after 5 and 13 years, with spinal radiographs evaluated using the modified Stoke AS Spinal Score (mSASSS). The results indicated a significant progression in spinal ankylosis over time, with an average increase in mSASSS of 1.6 points over five years and 2.7 points over 13 years, reflecting ongoing bone formation and spinal fusion.

The study identified several predictors associated with disease progression. Higher levels of C-reactive protein (CRP), obesity, and a higher initial mSASSS score were linked to increased spinal deterioration in both males and females. Additionally, exposure to tumor necrosis factor inhibitors (TNFi) or bisphosphonates was associated with more progression in women, while in men, smoking and carrying the HLA-B27 gene were significant risk factors.

Lead researcher Anna Deminger emphasized that, although the progression of new bone formation is generally slow, it continues steadily over many years in patients with longstanding r-axSpA. The findings highlight the importance of controlling inflammation since elevated CRP levels were strongly linked to worse radiographic outcomes. Moreover, modifiable factors such as smoking and body weight could influence disease course, suggesting potential areas for intervention.

This research underscores the need for personalized management strategies in r-axSpA and emphasizes the importance of early diagnosis and targeted treatment to slow spinal damage. Additional investigations are necessary to better understand why certain treatments like TNFi may be associated with increased progression in specific patient groups.

For more detailed information, refer to the study: Deminger A, et al. Predictors of spinal radiographic progression over up to 13 years in patients with radiographic axial spondyloarthritis. Presented at EULAR 2025; DOI: 10.1136/annrheumdis-2025-eular.B2838.