Radiographic damage and progression of the cervical spine in ankylosing spondylitis patients treated with TNF-alpha inhibitors: Facet joints vs. vertebral bodies

Fiona Maas*, Anneke Spoorenberg, Elisabeth Brouwer, Eveline van der Veer, Hendrika Bootsma, Reinhard Bos, Freke R. Wink, Suzanne Arends

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

19 Citations (Scopus)
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Objectives: To investigate radiographic damage and 4-year progression of the cervical facet joints in a prospective observational cohort of AS patients treated with TNF-alpha inhibitors, to compare this with damage and progression of the cervical vertebral bodies, and to study the relation with patient characteristics and clinical outcome.

Methods: Patients from the Groningen Leeuwarden AS (GLAS) cohort starting TNF-alpha 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.

Results: 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.

Conclusions: Cervical facet joints were frequently involved in AS. During 4 years of TNF-alpha blocking therapy, 13% of the patients showed radiographic progression of cervical facet joints of which the majority did not show progression of vertebral bodies. (C) 2017 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)562-568
Number of pages7
Issue number5
Early online date9-Nov-2016
Publication statusPublished - Apr-2017


  • Ankylosing spondylitis
  • Zygapophyseal joint
  • Radiographic progression
  • Bone formation
  • Tumor necrosis factor-alpha blocking therapy

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