Radiographic structural damage in axial spondyloarthritis: is there a preferred way to quantify progression over time? Comparison of blinded versus unblinded mSASSS scoring

Baraliakos, X; Protopopov, M; Rodriguez, VR; Torgutalp, M; Dilbaryan, A; Haibel, H; Sieper, J; Braun, J; Rudwaleit, M; Poddubnyy, D

doi:10.1016/j.ard.2025.03.017

Spondyloarthritis & psoriatic arthritis

Radiographic structural damage in axial spondyloarthritis: is there a preferred way to quantify progression over time? Comparison of blinded versus unblinded modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) scoring

Ann Rheum DisPublished 15 May 2025Methodological comparison study within a prospective inception cohort

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Authors' conclusion

More mSASSS progression was detected using unblinded vs blinded scoring.

Study context

Population: Axial spondyloarthritis (axSpA) patients in the German Spondyloarthritis Inception Cohort with cervical and lumbar radiographs at baseline and after 2 years51% male, 79% HLA-B27 positive
Participants: 210 patients

Exposure: Blinded vs unblinded mSASSS scoring of spinal radiographs
Outcome: Sensitivity to change of mSASSS (mean mSASSS progression)
Follow-up: 2 years

Methodological detailsblinded vs unblinded scoring, 5 experienced readers (2 blinded, 3 unblinded to chronology), national inception cohort (GESPIC), Mean scores of readers used for calculations

Blinded vs unblinded scoring
5 experienced readers (2 blinded, 3 unblinded to chronology)
National inception cohort (GESPIC)
Mean scores of readers used for calculations

Main finding

As reported in the abstract

Mean mSASSS progression

Blinded

0.7

mean · SD 2.3

Unblinded

1.0

mean · SD 1.9

P = 0.005

Observational data: associations, not effects.

Further findings

Progression of ≥2 mSASSS units · 2 years

Blinded14.3%

Unblinded17.6%

Shift analysis: vertebral edges with mSASSS worsening · 2 years

Blinded0.8%

Unblinded2.2%

Total vertebral edges Blinded 4.373 · Unblinded 4914

Shift analysis: vertebral edges with mSASSS improvement · 2 years

Blinded0.1%

Unblinded0.04%

Mean

Outcome	Blinded	Unblinded
Mean baseline mSASSS	4.2 (SD 8.3)	3.4 (SD 7.9)

Type of progression

The majority of progression was found for the development of syndesmophytes in both groups

Original publication

Radiographic structural damage in axial spondyloarthritis: is there a preferred way to quantify progression over time? Comparison of blinded versus unblinded mSASSS scoring. Ann Rheum Dis. Published 15 May 2025. doi:10.1016/j.ard.2025.03.017

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