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TOPLINE:

Higher comorbidity burden and extra-musculoskeletal manifestations, specifically uveitis and psoriasis, were independently associated with accelerated spinal radiographic progression in patients with ankylosing spondylitis (AS).

METHODOLOGY:

• Researchers analyzed data from an international prospective study to examine the associations of comorbidity burden and extra-musculoskeletal manifestations with radiographic progression in 1150 participants (mean age, 44 years; 75% male; 84% HLA-B27 positive) who met the modified New York criteria for AS.
• Participants had one or more lateral cervical or lumbar radiographs scored using the modified Stoke AS Severity Score (mSASSS ), with a score of 0 for normal vertebral corners, erosion, sclerosis, or squaring; 1 for a definite syndesmophyte; and 2 for complete bridging.
• Baseline exposures included comorbidity count (zero, one, two, and three or more from 22 self-reported conditions), and the presence or absence of extra-musculoskeletal manifestations (uveitis, psoriasis, and inflammatory bowel disease [IBD]). Patients were followed for a median duration of 2.1 years.

TAKEAWAY:

• Progression was greater among patients with two comorbidities (2.7 mSASSS units over 10 years; P < .001) and three or more comorbidities (2.3 units over 10 years; P < .001) than among those with no comorbidities, whereas having one comorbidity showed no significant association.
• Uveitis (equivalent to a difference of 2.2 mSASSS units over 10 years; P < .001) and psoriasis (2.4 units over 10 years; P < .001) were linked to greater radiographic progression, but IBD showed no significant association.
• In sex-stratified analyses, progression appeared greater in female patients with psoriasis (4.5 mSASSS units over 10 years; P = .001) than in male patients with psoriasis (1.8 units over 10 years; P = .005).

IN PRACTICE:

“[The] readily identifiable clinical features may help stratify individuals at higher risk and inform the use of targeted physical and pharmacological interventions,” the authors wrote.

SOURCE:

This study was led by Sizheng Steven Zhao, MB ChB, PhD, Centre for Musculoskeletal Research, The University of Manchester, Manchester, England. It was published online on May 9, 2026, in Rheumatology.

LIMITATIONS:

Radiographs were not scored by more than one person, which may introduce bias. Time-varying treatment data could not be aligned with the dates of radiographs. Ascertainment of extra-musculoskeletal manifestations by self-report was susceptible to misclassification and could bias estimates toward the null.

DISCLOSURES:

The project received support from a traveling fellowship from the British Society for Spondyloarthritis. One author reported receiving support from The University of Manchester Dean’s Prize and an Arthritis UK Career Development Fellowship.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.