What question did this study set out to answer?

To assess the transition from non-radiographic to radiographic axial spondyloarthritis and identify risk factors for this progression.

May 8, 2026Open Access

Progression of non-radiographic to radiographic axial spondyloarthritis: a risk model based on a chinese cohort study

Key Points

To assess the transition from non-radiographic to radiographic axial spondyloarthritis and identify risk factors for this progression.
Enrolled 572 patients with non-radiographic axial spondyloarthritis over a median follow-up of 5 years.
Conducted Cox proportional hazard regression analyses to identify risk factors for progression.
Developed a risk scoring system based on identified predictors to categorize patients into risk groups.
40.2% of patients progressed from non-radiographic to radiographic axial spondyloarthritis by follow-up.
Risk factors included unilateral grade II sacroiliitis, high disease activity, HLA-B27 positivity, and family history of spondyloarthritis, with varying hazard ratios in clinical and imaging arms.
The predictive model achieved AUCs ranging from 0.660 to 0.839 for progression prediction at different time points.

Abstract

OBJECTIVES: To evaluate the progression from non-radiographic axial spondyloarthritis (nr-axSpA) to radiographic axial spondyloarthritis (r-axSpA) in a Chinese cohort, identify associated risk factors in both clinical and imaging arms, and enable risk stratification based on these factors. METHODS: Overall, 572 patients with nr-axSpA were enrolled with a median follow-up of 5 years. Cox proportional hazard regression analyses were conducted to identify potential risk factors associated with the progression from nr-axSpA to r-axSpA in both clinical and imaging arms. A risk-scoring system was then developed by assigning each independent predictor a weight based on its regression coefficient. Patients were subsequently categorized into low-, medium-, and high-risk groups according to their cumulative scores. RESULTS: By the end of follow-up, 40.2% of nr-axSpA patients had progressed to r-axSpA, more frequently in the imaging arm than in the clinical arm (56.1% vs. 17.4%, P 2.1) were significant predictors of progression in both the imaging arm (HR = 2.00, 95% CI 1.40-2.86 and HR = 2.38, 95% CI 1.30-4.34, respectively) and the clinical arm (HR = 6.28, 95% CI 2.73-14.48 and HR = 3.68, 95% CI 1.08-12.51, respectively). HLA-B27 positivity (HR = 2.67, 95% CI 1.72-4.11) in the imaging arm and a family history of spondyloarthritis (HR = 2.72, 95% CI 1.18-6.28) in the clinical arm were associated with increased progression risk. Based on these factors, a predictive model classified patients into low-, medium-, and high-risk groups. In the imaging arm, the model achieved AUCs of 0.839, 0.777, and 0.807 for 3-, 5-, and 10-year progression rates, respectively; in the clinical arm, the corresponding AUCs were 0.660, 0.780, and 0.820. CONCLUSIONS: In the imaging arm, nr-axSpA patients progress to r-axSpA more rapidly and frequently than those in the clinical arm. Risk factors include unilateral grade II sacroiliitis, high disease activity, HLA-B27 positivity, and SpA family history. A risk scoring system was developed for progression prediction and personalized management. Large-scale prospective multicenter studies are needed to validate its clinical utility across diverse populations.

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