Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Comparison Between Inspire and Domjan Method for Measuring Lumbar Lateral Flexion in Patients of Psoriatic Arthritis (PsA) and Correlation with Radiographic Damage
Wakhlu1, Anupam, Phumethum1, Veerapong, Chandran1, Vinod, Schentag1, Catherine T., Shen2, Hua, Cook2, Richard J., Gladman1, Dafna
Assessment of spinal lateral flexion is important in the assessment of spondyloarthritis (SpA). The INSPIRE method of measuring spinal lateral flexion requires one set of measurements, is faster, feasible and correlated with the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) in patients with ankylosing spondylitis. The purpose of the present study is to compare the INSPIRE method of measuring lumbar lateral flexion to Domjan method in PsA patients and correlate it with radiographic changes.
Patients were selected from a longitudinal cohort followed in a PsA clinic since 1978. Detailed demographic and clinical data are obtained every 612 months and are tracked on a computerized database. Patients satisfying CASPAR criteria for PsA and axial disease were identified using radiological criteria, which included the presence of at least grade 2 sacroiliitis. Clinical features recorded systematically included the following: age, gender, ethnicity, age at symptom onset, age at diagnosis, arthritis pattern, family history, extra-articular manifestations and medications. The physical examination includes general physical examination, musculoskeletal examination and full spinal clinimetrics including measurement of INSPIRE and Domjan methods of spinal lateral flexion by trained rheumatologists. Spine radiographs, obtained every 2 years included AP pelvis, lateral view of cervical spine, AP and Lateral views of lumbar spine. These were scored by consensus for mSASSS by 2 assessors. Pearson correlation was used to correlate the values of spinal mobility measures and radiographic scores.
229 patients were included in the study of whom 43% were female. The mean age at study entry was 51 years (1683) and mean age at onset of PsA was 37 years. The mean disease duration was 15 years (0.549). 54% of patients had radiological evidence of sacroiliitis and 45% had evidence of degenerative spinal disease. The spinal mobility and radiographic scores were as follows [mean (minimum, maximum)]: Occiput-to-wall distance (cm)=1.0 (017), Tragus-to-wall distance (cm)=12 (725), Cervical rotation (degrees)=71 (590), Chest expansion (cm)=6 (212), Modified Schoeber (cm)=4.5 (18), Lateral spinal flexion-Domjan (cm)=16.5 (3.540), Lateral spinal flexion-INSPIRE (cm)=32 (860), mSASSS score=2 (048). Correlation (95% confidence interval) between INSPIRE and Domjan method was 0.86 (0.82,0.89), between INSPIRE, Domjan methods and mSASSS were -0.28 (-0.40,-0.16) and -0.27 (-0.39,-0.14) respectively. All correlations had a p value of <0.0001. Comparable correlations were obtained when comparisons were made in patients of PsA with axial disease only.
The study demonstrates that both INSPIRE and Domjam methods correlate well as measures of spinal lateral flexion in PsA and correlate well with radiographic damage. If the two show a similar sensitivity to change, they may be used interchangeably.
To cite this abstract, please use the following information:
Wakhlu, Anupam, Phumethum, Veerapong, Chandran, Vinod, Schentag, Catherine T., Shen, Hua, Cook, Richard J., et al; Comparison Between Inspire and Domjan Method for Measuring Lumbar Lateral Flexion in Patients of Psoriatic Arthritis (PsA) and Correlation with Radiographic Damage [abstract]. Arthritis Rheum 2009;60 Suppl 10 :546