Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: Construct validity, responsiveness and discriminatory ability of the anatomy-based CANDEN scoring system in a randomised placebo-controlled trial

Simon Krabbe; Inge J. Sørensen; Bente Jensen; Jakob M. Møller; Lone Balding; Ole R. Madsen; Robert G.W. Lambert; Walter P. Maksymowych; Susanne J. Pedersen; Mikkel Østergaard

doi:10.1136/rmdopen-2017-000624

Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: Construct validity, responsiveness and discriminatory ability of the anatomy-based CANDEN scoring system in a randomised placebo-controlled trial

Simon Krabbe^*, Inge J. Sørensen, Bente Jensen, Jakob M. Møller, Lone Balding, Ole R. Madsen, Robert G.W. Lambert, Walter P. Maksymowych, Susanne J. Pedersen, Mikkel Østergaard

^*Corresponding author for this work

14 Citations (Scopus)

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Abstract

Background The Canada-Denmark (CANDEN) definitions of spinal MRI lesions allow a detailed anatomy-based evaluation of inflammatory and structural lesions in vertebral bodies and posterior elements of the spine in patients with axial spondyloarthritis (axSpA). The objective was to examine the reliability, responsiveness and discrimination of scores for spinal inflammation, fat, bone erosion and new bone formation based on the CANDEN system and to describe patterns of inflammatory and structural lesions and their temporal development. Methods 49 patients with axSpA from an investigator-initiated, randomised, placebo-controlled trial of adalimumab underwent spinal MRI at weeks 0/6/24/48. MR images were scored according to the CANDEN system and the Spondyloarthritis Research Consortium of Canada (SPARCC) method. Total scores, and various subscores, were created by summing individual lesion scores. Results The CANDEN spine inflammation score had high responsiveness, similar to the SPARCC MRI spine index (Guyatt's responsiveness index 1.88 and 1.67, respectively), and discriminated between adalimumab and placebo treatment already at 6 weeks' follow-up (P=0.03). Anterior/posterior corner inflammation subscores showed similar responsiveness. Inter-reader reliability for the CANDEN spine inflammation and fat scores was good to very good for status and change scores (intraclass correlation coefficient (ICC)=0.71-0.92). Reliability for CANDEN new bone formation and erosion scores was good to very good for status scores (ICC=0.61-0.75) but, due to minimal progression, poor for change scores (ICC≤0.40). Conclusions The CANDEN spine inflammation score showed good responsiveness, discrimination between active treatment and placebo and reliability. The CANDEN spine structural scores had good cross-sectional reliability, but longer studies are needed to investigate their sensitivity to change.

Original language	English
Article number	e000624
Journal	RMD Open
Volume	4
Issue number	1
Number of pages	12
ISSN	2056-5933
DOIs	https://doi.org/10.1136/rmdopen-2017-000624
Publication status	Published - 2018

Keywords

inflammation
magnetic resonance imaging
outcomes research
spondylarthritis

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Krabbe, S., Sørensen, I. J., Jensen, B., Møller, J. M., Balding, L., Madsen, O. R., Lambert, R. G. W., Maksymowych, W. P., Pedersen, S. J., & Østergaard, M. (2018). Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: Construct validity, responsiveness and discriminatory ability of the anatomy-based CANDEN scoring system in a randomised placebo-controlled trial. RMD Open, 4(1), Article e000624. https://doi.org/10.1136/rmdopen-2017-000624

Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: Construct validity, responsiveness and discriminatory ability of the anatomy-based CANDEN scoring system in a randomised placebo-controlled trial. / Krabbe, Simon; Sørensen, Inge J.; Jensen, Bente et al.
In: RMD Open, Vol. 4, No. 1, e000624, 2018.

Research output: Contribution to journal › Journal article › Research › peer-review

Krabbe, S, Sørensen, IJ, Jensen, B, Møller, JM, Balding, L, Madsen, OR, Lambert, RGW, Maksymowych, WP, Pedersen, SJ & Østergaard, M 2018, 'Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: Construct validity, responsiveness and discriminatory ability of the anatomy-based CANDEN scoring system in a randomised placebo-controlled trial', RMD Open, vol. 4, no. 1, e000624. https://doi.org/10.1136/rmdopen-2017-000624

Krabbe S, Sørensen IJ, Jensen B, Møller JM, Balding L, Madsen OR et al. Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: Construct validity, responsiveness and discriminatory ability of the anatomy-based CANDEN scoring system in a randomised placebo-controlled trial. RMD Open. 2018;4(1):e000624. doi: 10.1136/rmdopen-2017-000624

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title = "Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: Construct validity, responsiveness and discriminatory ability of the anatomy-based CANDEN scoring system in a randomised placebo-controlled trial",

abstract = "Background The Canada-Denmark (CANDEN) definitions of spinal MRI lesions allow a detailed anatomy-based evaluation of inflammatory and structural lesions in vertebral bodies and posterior elements of the spine in patients with axial spondyloarthritis (axSpA). The objective was to examine the reliability, responsiveness and discrimination of scores for spinal inflammation, fat, bone erosion and new bone formation based on the CANDEN system and to describe patterns of inflammatory and structural lesions and their temporal development. Methods 49 patients with axSpA from an investigator-initiated, randomised, placebo-controlled trial of adalimumab underwent spinal MRI at weeks 0/6/24/48. MR images were scored according to the CANDEN system and the Spondyloarthritis Research Consortium of Canada (SPARCC) method. Total scores, and various subscores, were created by summing individual lesion scores. Results The CANDEN spine inflammation score had high responsiveness, similar to the SPARCC MRI spine index (Guyatt's responsiveness index 1.88 and 1.67, respectively), and discriminated between adalimumab and placebo treatment already at 6 weeks' follow-up (P=0.03). Anterior/posterior corner inflammation subscores showed similar responsiveness. Inter-reader reliability for the CANDEN spine inflammation and fat scores was good to very good for status and change scores (intraclass correlation coefficient (ICC)=0.71-0.92). Reliability for CANDEN new bone formation and erosion scores was good to very good for status scores (ICC=0.61-0.75) but, due to minimal progression, poor for change scores (ICC≤0.40). Conclusions The CANDEN spine inflammation score showed good responsiveness, discrimination between active treatment and placebo and reliability. The CANDEN spine structural scores had good cross-sectional reliability, but longer studies are needed to investigate their sensitivity to change.",

keywords = "inflammation, magnetic resonance imaging, outcomes research, spondylarthritis",

author = "Simon Krabbe and S{\o}rensen, {Inge J.} and Bente Jensen and M{\o}ller, {Jakob M.} and Lone Balding and Madsen, {Ole R.} and Lambert, {Robert G.W.} and Maksymowych, {Walter P.} and Pedersen, {Susanne J.} and Mikkel {\O}stergaard",

year = "2018",

doi = "10.1136/rmdopen-2017-000624",

language = "English",

volume = "4",

journal = "RMD Open",

issn = "2056-5933",

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TY - JOUR

T1 - Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis

T2 - Construct validity, responsiveness and discriminatory ability of the anatomy-based CANDEN scoring system in a randomised placebo-controlled trial

AU - Krabbe, Simon

AU - Sørensen, Inge J.

AU - Jensen, Bente

AU - Møller, Jakob M.

AU - Balding, Lone

AU - Madsen, Ole R.

AU - Lambert, Robert G.W.

AU - Maksymowych, Walter P.

AU - Pedersen, Susanne J.

AU - Østergaard, Mikkel

PY - 2018

Y1 - 2018

N2 - Background The Canada-Denmark (CANDEN) definitions of spinal MRI lesions allow a detailed anatomy-based evaluation of inflammatory and structural lesions in vertebral bodies and posterior elements of the spine in patients with axial spondyloarthritis (axSpA). The objective was to examine the reliability, responsiveness and discrimination of scores for spinal inflammation, fat, bone erosion and new bone formation based on the CANDEN system and to describe patterns of inflammatory and structural lesions and their temporal development. Methods 49 patients with axSpA from an investigator-initiated, randomised, placebo-controlled trial of adalimumab underwent spinal MRI at weeks 0/6/24/48. MR images were scored according to the CANDEN system and the Spondyloarthritis Research Consortium of Canada (SPARCC) method. Total scores, and various subscores, were created by summing individual lesion scores. Results The CANDEN spine inflammation score had high responsiveness, similar to the SPARCC MRI spine index (Guyatt's responsiveness index 1.88 and 1.67, respectively), and discriminated between adalimumab and placebo treatment already at 6 weeks' follow-up (P=0.03). Anterior/posterior corner inflammation subscores showed similar responsiveness. Inter-reader reliability for the CANDEN spine inflammation and fat scores was good to very good for status and change scores (intraclass correlation coefficient (ICC)=0.71-0.92). Reliability for CANDEN new bone formation and erosion scores was good to very good for status scores (ICC=0.61-0.75) but, due to minimal progression, poor for change scores (ICC≤0.40). Conclusions The CANDEN spine inflammation score showed good responsiveness, discrimination between active treatment and placebo and reliability. The CANDEN spine structural scores had good cross-sectional reliability, but longer studies are needed to investigate their sensitivity to change.

AB - Background The Canada-Denmark (CANDEN) definitions of spinal MRI lesions allow a detailed anatomy-based evaluation of inflammatory and structural lesions in vertebral bodies and posterior elements of the spine in patients with axial spondyloarthritis (axSpA). The objective was to examine the reliability, responsiveness and discrimination of scores for spinal inflammation, fat, bone erosion and new bone formation based on the CANDEN system and to describe patterns of inflammatory and structural lesions and their temporal development. Methods 49 patients with axSpA from an investigator-initiated, randomised, placebo-controlled trial of adalimumab underwent spinal MRI at weeks 0/6/24/48. MR images were scored according to the CANDEN system and the Spondyloarthritis Research Consortium of Canada (SPARCC) method. Total scores, and various subscores, were created by summing individual lesion scores. Results The CANDEN spine inflammation score had high responsiveness, similar to the SPARCC MRI spine index (Guyatt's responsiveness index 1.88 and 1.67, respectively), and discriminated between adalimumab and placebo treatment already at 6 weeks' follow-up (P=0.03). Anterior/posterior corner inflammation subscores showed similar responsiveness. Inter-reader reliability for the CANDEN spine inflammation and fat scores was good to very good for status and change scores (intraclass correlation coefficient (ICC)=0.71-0.92). Reliability for CANDEN new bone formation and erosion scores was good to very good for status scores (ICC=0.61-0.75) but, due to minimal progression, poor for change scores (ICC≤0.40). Conclusions The CANDEN spine inflammation score showed good responsiveness, discrimination between active treatment and placebo and reliability. The CANDEN spine structural scores had good cross-sectional reliability, but longer studies are needed to investigate their sensitivity to change.

KW - inflammation

KW - magnetic resonance imaging

KW - outcomes research

KW - spondylarthritis

U2 - 10.1136/rmdopen-2017-000624

DO - 10.1136/rmdopen-2017-000624

M3 - Journal article

AN - SCOPUS:85051239819

SN - 2056-5933

VL - 4

JO - RMD Open

JF - RMD Open

IS - 1

M1 - e000624

ER -