Logo of annrheumdAnnals of the Rheumatic DiseasesVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Ann Rheum Dis. 2005 Jul; 64(7): 988–994.
PMCID: PMC1755579

Association between radiographic damage of the spine and spinal mobility for individual patients with ankylosing spondylitis: can assessment of spinal mobility be a proxy for radiographic evaluation?


Objective: To demonstrate the association between various measures of spinal mobility and radiographic damage of the spine in individual patients with ankylosing spondylitis, and to determine whether the assessment of spinal mobility can be a proxy for the assessment of radiographic damage.

Methods: Radiographic damage was assessed by the mSASSS. Cumulative probability plots combined the radiographic damage score of an individual patient with the corresponding score for nine spinal mobility measures. Receiver operating characteristic analysis was performed to determine the cut off level of every spinal mobility measure that discriminates best between the presence and absence of radiographic damage. Three arbitrary cut off levels for radiographic damage were investigated. Likelihood ratios were calculated to explore further the diagnostic properties of the spinal mobility measures.

Results: Cumulative probability plots showed an association between spinal mobility measures and radiographic damage for the individual patient. Irrespective of the chosen cut off level for radiographic progression, lateral spinal flexion and BASMI discriminated best between patients with and those without structural damage. Even the best discriminatory spinal mobility assessments misclassified a considerable proportion of patients (up to 20%). Intermalleolar distance performed worst (up to 30% misclassifications). Lateral spinal flexion best predicted the absence of radiographic damage, and a modified Schober test best predicted the presence of radiographic damage.

Conclusion: This study unequivocally demonstrated a relationship between spinal mobility and radiographic damage. However, spinal mobility cannot be used as a proxy for radiographic evaluation in an individual patient.

Full Text

The Full Text of this article is available as a PDF (296K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kennedy LG, Jenkinson TR, Mallorie PA, Whitelock HC, Garrett SL, Calin A. Ankylosing spondylitis: the correlation between a new metrology score and radiology. Br J Rheumatol. 1995 Aug;34(8):767–770. [PubMed]
  • Viitanen JV, Kokko ML, Lehtinen K, Suni J, Kautiainen H. Correlation between mobility restrictions and radiologic changes in ankylosing spondylitis. Spine (Phila Pa 1976) 1995 Feb 15;20(4):492–496. [PubMed]
  • Viitanen JV, Kokko ML, Heikkilä S, Kautiainen H. Neck mobility assessment in ankylosing spondylitis: a clinical study of nine measurements including new tape methods for cervical rotation and lateral flexion. Br J Rheumatol. 1998 Apr;37(4):377–381. [PubMed]
  • Viitanen JV, Heikkilä S, Kokko ML, Kautiainen H. Clinical assessment of spinal mobility measurements in ankylosing spondylitis: a compact set for follow-up and trials? Clin Rheumatol. 2000;19(2):131–137. [PubMed]
  • Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielants H, van der Tempel H, van der Linden S. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol. 1999 Apr;26(4):980–984. [PubMed]
  • Creemers MCW, Franssen MJAM, van't Hof MA, Gribnau FWJ, van de Putte LBA, van Riel PLCM. Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system. Ann Rheum Dis. 2005 Jan;64(1):127–129. [PMC free article] [PubMed]
  • Spoorenberg A, de Vlam K, van der Heijde D, de Klerk E, Dougados M, Mielants H, van der Tempel H, Boers M, van der Linden S. Radiological scoring methods in ankylosing spondylitis: reliability and sensitivity to change over one year. J Rheumatol. 1999 Apr;26(4):997–1002. [PubMed]
  • Wanders Astrid J B, Landewé Robert B M, Spoorenberg Anneke, Dougados Maxime, van der Linden Sjef, Mielants Herman, van der Tempel Hille, van der Heijde Désirée M F M. What is the most appropriate radiologic scoring method for ankylosing spondylitis? A comparison of the available methods based on the Outcome Measures in Rheumatology Clinical Trials filter. Arthritis Rheum. 2004 Aug;50(8):2622–2632. [PubMed]
  • Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol. 1994 Sep;21(9):1694–1698. [PubMed]
  • Jones SD, Porter J, Garrett SL, Kennedy LG, Whitelock H, Calin A. A new scoring system for the Bath Ankylosing Spondylitis Metrology Index (BASMI) J Rheumatol. 1995 Aug;22(8):1609–1609. [PubMed]
  • Landewé Robert B M, van der Heijde Désirée M F M. Principles of assessment from a clinical perspective. Best Pract Res Clin Rheumatol. 2003 Jun;17(3):365–379. [PubMed]
  • de Vlam K, Mielants H, Veys EM. Involvement of the zygapophyseal joint in ankylosing spondylitis: relation to the bridging syndesmophyte. J Rheumatol. 1999 Aug;26(8):1738–1745. [PubMed]

Figures and Tables

Figure 1
 Cumulative probability plots of mSASSS versus spinal mobility measures. (A) mSASSS versus chest expansion; (B) mSASSS versus finger to floor distance; (C) mSASSS versus occiput to wall distance; (D) mSASSS versus tragus to wall distance; (E) ...
Figure 2
 Cumulative probability plots for mSASSS versus modified Schober with cut off points for mSASSS and modified Schober creating four quadrants. (A) cut off mSASSS >0; (B) cut off mSASSS >3; (C) cut off mSASSS >6.

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...