title: MRI inflammation at the vertebral unit only marginally predicts new syndesmophyte formation: a multilevel analysis in patients with ankylosing spondylitis.
abstract: OBJECTIVE
  To investigate the relationship between MRI inflammation at the vertebral unit and the formation and growth of syndesmophytes at the same vertebral unit.
  
  
  METHODS
  An 80% random sample of the ASSERT database was analysed. MRI were scored using the ankylosing spondylitis (AS) spinal MRI activity score (at baseline, 24 and 102 weeks) and spinal x-rays were scored using the modified Stoke AS spine score (at baseline and 102 weeks). Data were analysed at the patient level and the vertebral unit level using a multilevel approach to adjust for within-patient correlation.
  
  
  RESULTS
  There was a slightly increased probability of developing syndesmophytes in vertebral units with MRI activity, which was maintained after adjustment for within-patient correlation (per vertebral unit level) and treatment, and after further adjustment for potential confounders, resulting in significant OR ranging from 1.51 to 2.26. Growth of existing syndesmophytes at the vertebral unit level was not associated with MRI activity. At the patient level only a trend for an association was observed.
  
  
  CONCLUSIONS
  MRI inflammation in a vertebral unit slightly increases the propensity to form a new syndesmophyte in the same vertebral unit, but does not predict the growth of already existing syndesmophytes. Despite this association, the large majority of new syndesmophytes developed in vertebral units without inflammation. The subtle association at the vertebral unit level did not translate into an association at the patient level.
authors: Rheumatology Department, Leiden University Medical Center, Leiden, The Netherlands. d.vanderheijde@kpnplanet.nl
authors: Désirée
authors: D
authors: van der Heijde
authors: Pedro
authors: P
authors: Machado
authors: Jürgen
authors: J
authors: Braun
authors: Kay-Geert A
authors: KG
authors: Hermann
authors: Xenofon
authors: X
authors: Baraliakos
authors: Benjamin
authors: B
authors: Hsu
authors: Daniel
authors: D
authors: Baker
authors: Robert
authors: R
authors: Landewé
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D012720:Severity of Illness Index; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology*; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging