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Article ; Online: Disease modification in axial spondyloarthritis - still a controversy?

de Hooge, Manouk / van der Heijde, Désirée

2024

Abstract: Purpose of review: This review evaluates recent advancements in disease-modifying therapies for axial spondyloarthritis (axSpA).: Recent findings: A recent study could not demonstrate an additional effect of NSAID therapy on golimumab [Tumor Necrosis ...

Abstract	Purpose of review: This review evaluates recent advancements in disease-modifying therapies for axial spondyloarthritis (axSpA). Recent findings: A recent study could not demonstrate an additional effect of NSAID therapy on golimumab [Tumor Necrosis Factor-α inhibitor (TNFi)] on structural progression; however, this might be due to the fact that the study was underpowered. While DMARDs have shown promise in suppressing inflammation, their impact on structural progression remains uncertain. A well powered trial showed no difference in spinal progression between secukinumab [Interleukin17A inhibitor (IL17Ai)] and adalimumab-biosimilar (TNFi). Preliminary data on Janus kinase inhibitors (JAKi) focus on MRI findings but lack evidence on radiographic spinal progression. While some studies suggest promising outcomes, others reveal limitations and inconclusive findings. Summary: Recent studies explore the effectiveness of NSAIDs, biological disease-modifying antirheumatic drugs like TNFi and IL-17i, as well as JAK inhibitors in axSpA. Conflicting evidence surrounds these therapies' ability to impede structural progression, with challenges in study design and interpretation. Moreover, changes in demographics and treatment methods underscore the importance of examining trends over time when assessing disease outcomes. Ultimately, ongoing research could benefit from new imaging tools when evaluating therapeutic strategies for modifying disease progression in axSpA.
Language	English
Publishing date	2024-05-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	1045317-9
ISSN	1531-6963 ; 1040-8711
ISSN (online)	1531-6963
ISSN	1040-8711
DOI	10.1097/BOR.0000000000001025
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Article ; Online: The Future of Imaging in Axial Spondyloarthritis.

de Hooge, Manouk

Rheumatic diseases clinics of North America

2020 Volume 46, Issue 2, Page(s) 297–309

Abstract: This article discusses the current position of conventional radiography and MRI, the techniques recommended by the European League Against Rheumatism for use in imaging in axial spondyloarthritis (axSpA). Several challenges and areas of development ... ...

Abstract	This article discusses the current position of conventional radiography and MRI, the techniques recommended by the European League Against Rheumatism for use in imaging in axial spondyloarthritis (axSpA). Several challenges and areas of development regarding radiography and MRI in axSpA are considered. Also, a few interesting focus points for future research are noted. Besides the recommended techniques, this article discusses several nuclear imaging techniques and the usability of these techniques in daily practice.
MeSH term(s)	Forecasting ; Humans ; Magnetic Resonance Imaging/methods ; Magnetic Resonance Imaging/trends ; Practice Guidelines as Topic ; Radiography/methods ; Radiography/trends ; Radionuclide Imaging/trends ; Sacroiliac Joint/diagnostic imaging ; Spondylarthritis/diagnostic imaging
Language	English
Publishing date	2020-04-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	92118-x
ISSN	1558-3163 ; 0889-857X
ISSN (online)	1558-3163
ISSN	0889-857X
DOI	10.1016/j.rdc.2020.01.005
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Article ; Online: Magnetic resonance imaging in spondyloarthritis: Friend or Foe?

de Hooge, Manouk / Diekhoff, Torsten / Poddubnyy, Denis

Best practice & research. Clinical rheumatology

2023 Volume 37, Issue 3, Page(s) 101874

Abstract: Magnetic resonance imaging (MRI) has emerged as a valuable tool for early detection and of axial spondyloarthritis (axSpA). A standardized imaging acquisition protocol, aligned with the current state-of-the-art, is crucial to obtain MRI scans that meet ... ...

Abstract	Magnetic resonance imaging (MRI) has emerged as a valuable tool for early detection and of axial spondyloarthritis (axSpA). A standardized imaging acquisition protocol, aligned with the current state-of-the-art, is crucial to obtain MRI scans that meet the diagnostic quality requirements. It is important to note that certain lesions, particularly bone marrow edema (BME), can be induced by mechanical stress or be a manifestation of another non-inflammatory disorder and may mimic the characteristic findings of axSpA on MRI. Therefore, a thorough assessment of MRI lesions, considering their localization and presence of highly specific features such as erosions and backfill, becomes imperative. Additionally, the application of additional imaging modalities, when necessary, can contribute to the differentiation of axSpA from other conditions that may exhibit similar MRI findings. This review provides recommendations on how to perform MRI in daily clinical practice and how to interpret finding from the differential diagnostic point of view.
MeSH term(s)	Humans ; Sacroiliac Joint ; Spondylarthritis/diagnosis ; Magnetic Resonance Imaging/methods ; Bone Marrow Diseases/pathology ; Axial Spondyloarthritis
Language	English
Publishing date	2023-11-11
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2052323-3
ISSN	1532-1770 ; 1521-6942
ISSN (online)	1532-1770
ISSN	1521-6942
DOI	10.1016/j.berh.2023.101874
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Article ; Online: Specific descriptions of axial involvement are associated with radiographic damage development after 2 years in psoriatic arthritis patients.

de Hooge, Manouk / Ischenko, Alla / Steinfeld, Serge / Nzeusseu, Adrien / Elewaut, Dirk / Lories, Rik / Van den Bosch, Filip / De Vlam, Kurt

Annals of the rheumatic diseases

2024 Volume 83, Issue 2, Page(s) 194–198

Abstract: Objectives: Investigating the association between different definitions of axial involvement and syndesmophytes development over 2 years in patients with psoriatic arthritis (PsA).: Methods: Patients from a prospective multicentre cohort (Belgian ... ...

Abstract	Objectives: Investigating the association between different definitions of axial involvement and syndesmophytes development over 2 years in patients with psoriatic arthritis (PsA). Methods: Patients from a prospective multicentre cohort (Belgian Epidemiological Psoriatic Arthritis Study) involving 17 Belgian rheumatology practices were recruited between December 2012 and July 2014 and included when fulfilling the Classification Criteria for Psoriatic Arthritis. Axial involvement included six clinical and two radiographic oriented definitions.Two calibrated central readers evaluated radiographic damage by assessing the modified Stoke Ankylosing Spondylitis Spinal Score and modified New York criteria. New syndesmophytes after 2 years were described conditional on axial involvement at baseline. Logistic regression analyses were used to investigate the association between syndesmophyte development and axial involvement. All definitions of axial involvement were evaluated separately. Results: From 150 patients, a 2-year follow-up of spinal radiographs was obtained. There are 11 patients with new syndesmophytes after 2 years. For the clinical definitions of axial involvement 'global assessment', 'detailed assessment', 'back pain (BP)' and 'inflammatory BP (IBP)' the probabilities of developing syndesmophytes ranged between 0.06 and 0.08 and were similar for the presence or absence of the definition. When including elevated C reactive protein (CRP) to the definitions the probability of developing syndesmophytes over 2 years increased two times for CBP and seven times for IBP.With radiographic axial involvement a similar trend was seen; radiographic sacroiliitis as definition showed a probability three times higher. When combined with elevated CRP there would be a 14 times higher chance to develop syndesmophytes in 2 years. The ORs varied from 0.83 to 13.80, though none of them were statistically significant. Conclusions: The likelihood of syndesmophyte formation in PsA is low. The probability of developing syndesmophytes is much higher when axial involvement is determined radiographically rather than clinically, particularly in the context of high CRP.
MeSH term(s)	Humans ; Arthritis, Psoriatic/diagnostic imaging ; Arthritis, Psoriatic/complications ; Prospective Studies ; Spine ; Spondylitis, Ankylosing/complications ; Sacroiliitis/complications
Language	English
Publishing date	2024-01-11
Publishing country	England
Document type	Journal Article
ZDB-ID	7090-7
ISSN	1468-2060 ; 0003-4967
ISSN (online)	1468-2060
ISSN	0003-4967
DOI	10.1136/ard-2023-224501
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Article ; Online: Atlas for the CT Syndesmophyte Score (CTSS) in patients with axial spondyloarthritis.

Marques, Mary Lucy / Ramiro, Sofia / van der Heijde, Désirée / Reijnierse, Monique / Diekhoff, Torsten / Hermann, Kay Geert A / van Gaalen, Floris A / de Hooge, Manouk

RMD open

2024 Volume 10, Issue 1

Abstract: Background: The Computed Tomography Syndesmophyte Score (CTSS) was developed as a reliable and sensitive tool to assess syndesmophytes in low-dose CT images of the entire spine in patients with axial spondyloarthritis (axSpA). The original paper ... ...

Abstract	Background: The Computed Tomography Syndesmophyte Score (CTSS) was developed as a reliable and sensitive tool to assess syndesmophytes in low-dose CT images of the entire spine in patients with axial spondyloarthritis (axSpA). The original paper provided sparce examples of the CTSS grades. Objectives: Provide an atlas tailored to assist readers in understanding and employing the CTSS method. Methods: In this paper, illustrations of the different grades and views of the CTSS are presented. CTSS is used to measure bone formation in the spine of patients with axial spondyloarthritis (axSpA), in the form of syndesmophytes. In both the sagittal and coronal planes, syndesmophytes can be graded from 0 to 3 over 23 vertebral units starting at C2 and ending at S1. The CTSS ranges from 0 (absence of axSpA-related syndesmophytes) to 552 (total ankylosis of the spine). Results: The current atlas contains low-dose CT images of the spine without lesions (for reference) and all grades of syndesmophytes in different planes used in the CTSS. Examples are arranged per spinal segment (cervical, thoracic and lumbar). Conclusions: These images can be used to assist any reader in the assessment of syndesmophytes on (low-dose) CT in patients with axSpA.
MeSH term(s)	Humans ; Axial Spondyloarthritis ; Spine ; Osteogenesis ; Tomography, X-Ray Computed
Language	English
Publishing date	2024-01-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2812592-7
ISSN	2056-5933 ; 2056-5933
ISSN (online)	2056-5933
ISSN	2056-5933
DOI	10.1136/rmdopen-2023-003702
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Article ; Online: Sacroiliac radiographic progression over 10 years in axSpA: data from the DESIR inception cohort.

Molto, Anna / López-Medina, Clementina / Sepriano, Alexandre / Ramiro, Sofia / de Hooge, Manouk / van Lunteren, Miranda / Navarro-Compán, Victoria / Wendling, Daniel / Dougados, Maxime

Annals of the rheumatic diseases

2024

Abstract: Objectives: To evaluate sacroiliac radiographic progression over a 10-year follow-up and determine the baseline factors associated with such progression in patients with recent-onset axial spondyloarthritis (axSpA, <3 years).: Methods: This analysis ... ...

Abstract	Objectives: To evaluate sacroiliac radiographic progression over a 10-year follow-up and determine the baseline factors associated with such progression in patients with recent-onset axial spondyloarthritis (axSpA, <3 years). Methods: This analysis was performed in the DESIR cohort (NCT01648907). The radiographic status of the patients (radiographic axSpA (r-axSpA) vs non-radiographic axSpA (nr-axSpA)) was based on the modified New York (mNY) criteria. Information on mNY criteria on the pelvic radiographs was obtained in four reading waves over a 10-year period. Images were blinded and centrally read by 3 trained readers. The % of mNY net progressors (ie, number of 'progressors' minus number of 'regressors' divided by the total number of patients) was assessed in completers (ie, pelvic radiographs at baseline and 10 years). The yearly likelihood of mNY+ was estimated using an integrated analysis (ie, including all patients with at least one available mNY score ('intention-to-follow' population) using a generalised estimating equations model and time-varying tumour necrosis factor (TNF) use as a confounder. Baseline predictors of mNY+ during 10 years were evaluated. Results: Completers included 294 patients, while intention-to-follow included 659 participants. In the completers, the net % progression (from nr-axSpA to r-axSpA) was 5.8%. In the intention-to-follow population, the probability of being mNY+ was estimated to increase 0.87% (95% CI 0.56 to 1.19) per year (ie, 8.7% after 10 years) while when introducing TNF inhibitors (TNFi) as a time-varying covariate, the probability was 0.45% (95% CI 0.09 to 0.81) (ie, 4.5% after 10 years). Baseline bone marrow oedema (BME) on MRI of the sacroiliac joints (SIJ) was associated with being mNY+ over time OR 6.2 (95% CI 5.3 to 7.2) and OR 3.1 (95% CI 2.4 to 3.9) in HLA-B27+ and HLA-B27-, respectively). Male sex, symptom duration >1.5 years, Axial Spondyloarthritis Disease Activity Score ≥2.1 and smoking (only in HLA-B27 positives) were also associated with being mNY+ over 10 years. BME was not found to be a mediator of the HLA-B27 effect on mNY+ at 10 years. Conclusions: The yearly likelihood of switching from nr-axSpA to r-axSpA in patients after 10 years of follow-up was low, and even lower when considering TNFi use.
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Journal Article
ZDB-ID	7090-7
ISSN	1468-2060 ; 0003-4967
ISSN (online)	1468-2060
ISSN	0003-4967
DOI	10.1136/ard-2023-225184
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Article ; Online: Erosions on T1-Weighted Magnetic Resonance Imaging Versus Radiography of Sacroiliac Joints in Recent-Onset Axial Spondyloarthritis: 2-Year Data (EMBARK Trial and DESIR Cohort).

Maksymowych, Walter P / Claudepierre, Pascal / de Hooge, Manouk / Lambert, Robert G / Landewé, Robert / Molto, Anna / van der Heijde, Désirée / Bukowski, Jack F / Jones, Heather / Pedersen, Ron / Szumski, Annette / Vlahos, Bonnie / Dougados, Maxime

The Journal of rheumatology

2024 Volume 51, Issue 5, Page(s) 462–471

Abstract: Objective: (1) To compare the capacity to detect sacroiliac joint (SIJ) erosions and baseline-to-week 104 change in erosions between magnetic resonance imaging (MRI) and radiographs in recent-onset axial spondyloarthritis (axSpA); and (2) to compare ... ...

Abstract	Objective: (1) To compare the capacity to detect sacroiliac joint (SIJ) erosions and baseline-to-week 104 change in erosions between magnetic resonance imaging (MRI) and radiographs in recent-onset axial spondyloarthritis (axSpA); and (2) to compare treatment-discriminatory capacities of MRI and radiographic scores for erosion detection in patients receiving etanercept in the Effect of Etanercept on Symptoms and Objective Inflammation in Nonradiographic axSpA (EMBARK) trial vs controls in the DESIR ( Methods: Anonymized SIJ MRI and radiographs were assessed at patient and joint surface levels. Three readers evaluated MRI; 3 different readers evaluated radiographs. Final scores for comparison of radiographs and MRI for detection of erosions were assigned based on agreement of ≥ 2 of 3 readers' assessments. Results: At baseline, discordance in erosion detection between imaging methods was more frequent for MRI erosions in the absence of radiographic erosions (48/224 [21.4%] patients) than for radiographic erosions in the absence of MRI erosions (14/224 [6.3%] patients; Conclusion: In recent-onset axSpA, SIJ erosions and erosion change were observed more frequently on MRI than radiography. The significance of interval improvement of MRI erosions warrants further research. [ClinicalTrials.gov: NCT01258738, NCT01648907].
MeSH term(s)	Humans ; Sacroiliac Joint/diagnostic imaging ; Sacroiliac Joint/pathology ; Magnetic Resonance Imaging/methods ; Adult ; Female ; Male ; Axial Spondyloarthritis/diagnostic imaging ; Axial Spondyloarthritis/drug therapy ; Etanercept/therapeutic use ; Radiography ; Antirheumatic Agents/therapeutic use ; Treatment Outcome ; Severity of Illness Index ; Middle Aged
Chemical Substances	Etanercept (OP401G7OJC) ; Antirheumatic Agents
Language	English
Publishing date	2024-05-01
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Comparative Study
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.2023-0906
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Article ; Online: Do fatty lesions explain the effect of inflammation on new syndesmophytes in patients with radiographic axial spondyloarthritis? Results from the SIAS cohort and ASSERT trial.

Stal, Rosalinde / Ramiro, Sofia / van der Heijde, Desirée / van Gaalen, Floris A / Baraliakos, Xenofon / Machado, Pedro M / de Hooge, Manouk / van den Berg, Rosaline / Reijnierse, Monique / Braun, Juergen / Landewé, Robert / Sepriano, Alexandre

RMD open

2023 Volume 9, Issue 3

Abstract: Objectives: To determine how much of the effect of vertebral corner inflammation on development of syndesmophytes is explained by vertebral corner fat deposition.: Methods: Patients with radiographic axial spondyloarthritis (r-axSpA) from the SIAS ( ... ...

Abstract	Objectives: To determine how much of the effect of vertebral corner inflammation on development of syndesmophytes is explained by vertebral corner fat deposition. Methods: Patients with radiographic axial spondyloarthritis (r-axSpA) from the SIAS (Sensitive Imaging in Ankylosing Spondylitis) cohort and ASSERT (Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy) trial were assessed at T0, T1 (SIAS: 1 year; ASSERT: 24 weeks) and T2 (2 years). Syndesmophytes assessed in each vertebral corner by whole spine low-dose CT (SIAS) or spinal radiographs (ASSERT) at T0 and T2 were considered present if seen by two of two readers. Inflammation (T0) and fat deposition (T0 and T1) on MRI were present if seen by ≥2 of 3 readers (SIAS) or 2 of 2 readers (ASSERT). Vertebral corners showing fat deposition or a syndesmophyte at baseline were ignored. Mediation analysis was applied to determine what proportion of the total effect of inflammation on syndesmophyte formation could be explained via the path of intermediate fat deposition. Results: Forty-nine SIAS patients (with 2667 vertebral corners) and 168 ASSERT patients (with 2918 vertebral corners) were analysed. The presence of inflammation at T0 increased the probability of a new syndesmophyte in the same vertebral corner at T2 by 9.3%. Of this total effect, 0.2% (2% (0.2 of 9.3) of the total effect) went via intermediate new fat deposition. In ASSERT, the total effect was 7.3%, of which 0.8% (10% of the total effect) went via new fat deposition. Conclusion: In r-axSpA, vertebral corner inflammation may lead to syndesmophyte formation but in a minority of cases via visible fat deposition.
MeSH term(s)	Humans ; Inflammation ; Magnetic Resonance Imaging ; Radiography ; Spine/diagnostic imaging ; Spine/pathology ; Spondylitis, Ankylosing/drug therapy
Language	English
Publishing date	2023-07-05
Publishing country	England
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2812592-7
ISSN	2056-5933 ; 2056-5933
ISSN (online)	2056-5933
ISSN	2056-5933
DOI	10.1136/rmdopen-2023-003118
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Article ; Online: Extent of axial damage in psoriatic arthritis and spondyloarthritis: comparative data from the BEPAS and (Be-)GIANT multicentre cohorts.

de Hooge, Manouk / Ishchenko, Alla / De Craemer, Ann-Sophie / Steinfeld, Serge / Nzeusseu, Adrien / Elewaut, Dirk / Lories, Rik / de Vlam, Kurt / Van den Bosch, Filip

RMD open

2023 Volume 9, Issue 2

Abstract: Background: To examine radiographic axial damage of the sacroiliac joints and spine in patients with psoriatic arthritis (PsA) and spondyloarthritis (SpA) in private and academic Belgian practices.: Methods: Patients with PsA with clinical diagnosis ... ...

Abstract	Background: To examine radiographic axial damage of the sacroiliac joints and spine in patients with psoriatic arthritis (PsA) and spondyloarthritis (SpA) in private and academic Belgian practices. Methods: Patients with PsA with clinical diagnosis of PsA and fulfilling the Classification Criteria for Psoriatic Arthritis from the prospective Belgian Epidemiological Psoriatic Arthritis Study and patients with SpA fulfilling the Assessment of SpondyloArthritis international Society classification criteria for SpA originate from the Ghent and BelGian Inflammatory Arthritis and spoNdylitis cohorTs were included in this study. Baseline pelvic and spinal radiographs were analysed by two calibrated readers. Blinded for the origin of the cohort or clinical data readers assessed the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and modified New York criteria on spinal and pelvic radiographs, respectively. Data were compared between both patient groups. Results: Of the 525 patients included (312 PsA and 213 SpA), most patients showed normal spinal radiographs: 87.5% of the patients with PsA and 92.0% of the patients with SpA. Patients with SpA with spinal damage show higher mSASSS than the patients with PsA (p<0.05). In patients with PsA, cervical spine is more often affected; 24/33 patients (72.7%) compared with lumbar spine 11/33 (33.3%). While in patients with SpA, syndesmophyte location was more evenly distributed; cervical 9/14 (64.3%) and lumbar 10/14 (71.4%). Conclusion: Minimal radiographic spinal damage was observed in Belgian patients with PsA or SpA. Patients with SpA tend to have higher mSASSS values and more syndesmophytes compared with PsA. Syndesmophytes were more often located in the cervical spine of patients with PsA, while the location was equally distributed in axSpA.
MeSH term(s)	Humans ; Arthritis, Psoriatic/complications ; Arthritis, Psoriatic/epidemiology ; Prospective Studies ; Spondylarthritis/complications ; Spondylarthritis/diagnosis ; Spondylarthritis/epidemiology ; Spondylitis, Ankylosing/complications ; Spondylitis, Ankylosing/epidemiology ; Spondylarthropathies ; Lumbar Vertebrae
Language	English
Publishing date	2023-05-03
Publishing country	England
Document type	Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2812592-7
ISSN	2056-5933 ; 2056-5933
ISSN (online)	2056-5933
ISSN	2056-5933
DOI	10.1136/rmdopen-2023-002994
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Article ; Online: Impact of sex on spinal radiographic progression in axial spondyloarthritis: a longitudinal Swiss cohort analysis over a period of 10 years.

Ensslin, Caroline / Micheroli, Raphael / Kissling, Seraphina / Götschi, Andrea / Bürki, Kristina / Bräm, René / de Hooge, Manouk / Baraliakos, Xenofon / Nissen, Michael J / Möller, Burkhard / Exer, Pascale / Andor, Michael / Distler, Oliver / Scherer, Almut / Ciurea, Adrian

RMD open

2023 Volume 9, Issue 3

Abstract: Objective: To investigate sex differences in spinal radiographic progression in axial spondyloarthritis (axSpA).: Methods: AxSpA patients in the Swiss Clinical Quality Management cohort with available spinal radiographs every 2 years were included. ... ...

Abstract	Objective: To investigate sex differences in spinal radiographic progression in axial spondyloarthritis (axSpA). Methods: AxSpA patients in the Swiss Clinical Quality Management cohort with available spinal radiographs every 2 years were included. Paired radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Progression was defined as an increase of ≥2 mSASSS units in 2 years. The relationship between sex and progression was investigated with binomial generalised estimating equation models, considering baseline spinal damage as an intermediate covariate. Additional analyses included adjustments for explanatory variables and multiple imputations for missingness. Results: In a total of 505 axSpA patients (317 men and 188 women), mean±SD radiographic progression over 2 years was 1.0±2.8 years in men and 0.3±1.1 years in women (p<0.001). Male sex was associated with enhanced progression in a small model not including baseline damage (OR 3.41, 95% CI 1.87 to 6.21). Both a direct effect of male sex on spinal progression, and an indirect effect, via enhancement of baseline spinal damage were significant (OR 2.06, 95% CI 1.15 to 3.67 and OR 1.04, 95% CI 1.01 to 1.07, respectively). A significant impact of male sex on spinal radiographic progression was still demonstrated after multiple adjustments for covariates known to potentially affect spinal radiographic progression (OR 1.97, 95% CI 1.04 to 3.71). Conclusions: Spinal radiographic progression in axSpA is more severe in men than in women, with three times higher odds of progression in male patients and an effect that is mediated in part through an increase in baseline radiographic damage.
MeSH term(s)	Humans ; Male ; Female ; Switzerland/epidemiology ; Disease Progression ; Spondylitis, Ankylosing/diagnostic imaging ; Spondylitis, Ankylosing/epidemiology ; Spine/diagnostic imaging ; Cohort Studies
Language	English
Publishing date	2023-07-26
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2812592-7
ISSN	2056-5933 ; 2056-5933
ISSN (online)	2056-5933
ISSN	2056-5933
DOI	10.1136/rmdopen-2023-003340
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