title: Radiographic damage and progression of the cervical spine in ankylosing spondylitis patients treated with TNF-α inhibitors: Facet joints vs. vertebral bodies.
abstract: To investigate radiographic damage and 4-year progression of the cervical facet joints in a prospective observational cohort of AS patients treated with TNF-α inhibitors, to compare this with damage and progression of the cervical vertebral bodies, and to study the relation with patient characteristics and clinical outcome.
  
  
  
  Patients from the Groningen Leeuwarden AS (GLAS) cohort starting TNF-α inhibitors with baseline and 4-year radiographs were included. Cervical facet joints and vertebral bodies were scored by two independent readers according to the method of de Vlam and mSASSS, respectively.
  
  
  
  At baseline, 25 of 99 (25%) AS patients had partial or complete ankylosis of the cervical facet joints, whereas 51 (52%) patients had non-bridging or bridging syndesmophytes of cervical vertebral bodies. During 4 years, 13 (13%) patients developed new (partial) ankylosis of the facet joints, whereas 26 (26%) developed new (bridging) syndesmophytes. Facet joint damage and progression without involvement of the vertebral bodies were seen in 5 (5%) and 8 (8%) patients, respectively. Damage of facet joints was associated with longer disease duration, history of IBD/uveitis/psoriasis, higher disease activity, larger occiput-to-wall distance, higher mSASSS, and presence of syndesmophytes. Progression of the facet joints was associated with larger occiput-to-wall distance and more facet joint damage at baseline.
  
  
  
  Cervical facet joints were frequently involved in AS. During 4 years of TNF-α blocking therapy, 13% of the patients showed radiographic progression of cervical facet joints of which the majority did not show progression of vertebral bodies.
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: f.maas@umcg.nl.
authors.forename: Fiona
authors.initials: F
authors.lastname: Maas
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Anneke
authors.initials: A
authors.lastname: Spoorenberg
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Brouwer
authors.affiliation: Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Eveline
authors.initials: E
authors.lastname: van der Veer
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Hendrika
authors.initials: H
authors.lastname: Bootsma
authors.affiliation: Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Bos
authors.affiliation: Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Freke R
authors.initials: FR
authors.lastname: Wink
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Arends
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*
chemical_list: D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Ankylosing spondylitis; Bone formation; Radiographic progression; Tumor necrosis factor-alpha blocking therapy; Zygapophyseal joint