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 < 0.001). Multivariate Cox regression analysis showed that unilateral grade II radiographic sacroiliitis and high disease activity (ASDAS-CRP > 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.
Keywords
ankylosing spondylitis, axial spondyloarthritis, non-radiographic axial spondyloarthritis, radiographic progression, risk factors
Document Type
Journal Article
Date of Publication
12-1-2026
E-ISSN
25201026
Volume
10
Issue
1
Publication Title
BMC Rheumatology
Publisher
Springer
School
School of Medical and Health Sciences / Centre for Precision Health
Funding Information
This study was supported by grants from the Basic and Applied Basic Research Foundation of Guangdong Province (2024A1515012910), the Special Funds for Science and Technology Planning Project of Guangdong Province (210715106900976), the Chronic Disease Management Research Project of National Health Commission Capacity Building and Continuing Education Center (GWJJMB202510025061), the grants from the Guangdong Medical Research Foundation (A2018104), and the Shantou Science and Technology Project ([2017]85, [2022]88).
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.