{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:42:21Z","timestamp":1791981741053,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2013,9,24]],"date-time":"2013-09-24T00:00:00Z","timestamp":1379980800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis &amp; Rheumatism"],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To study the effect of tumor necrosis factor \u03b1 (TNF\u03b1) inhibitors on progressive spinal damage in patients with ankylosing spondylitis (AS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All AS patients meeting the modified New York criteria who had been monitored prospectively and had at least 2 sets of spinal radiographs a minimum of 1.5 years apart were included in the study (n = 334). The patients received standard therapy, which included nonsteroidal antiinflammatory drugs and TNF\u03b1 inhibitors. Radiographic severity was assessed by the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Patients with a rate of AS progression that was \u22651 mSASSS unit\/year were considered progressors. Univariable and multivariable regression analyses were done. Propensity score matching and sensitivity analysis were performed. A zero\u2010inflated negative binomial (ZINB) model was used to analyze the effect of TNF\u03b1 inhibitors on the change in the mSASSS with varying followup periods. Potential confounders, such as disease activity (as assessed by the Bath Ankylosing Spondylitis Disease Activity Index), the erythrocyte sedimentation rate, C\u2010reactive protein level, HLA\u2013B27 positivity, sex, age at onset, smoking burden (number of pack\u2010years), and baseline damage, were included in the model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>TNF\u03b1 inhibitor treatment was associated with a 50% reduction in the odds of progression, with an odds ratio (OR) of 0.52 (95% confidence interval [95% CI] 0.30\u20130.88, <jats:italic>P<\/jats:italic> = 0.02). Patients with a delay of &gt;10 years in starting therapy were more likely to experience progression as compared to those who started earlier (OR 2.4 [95% CI 1.09\u20135.3], <jats:italic>P<\/jats:italic> = 0.03). In the ZINB model, the use of TNF\u03b1 inhibitors significantly reduced disease progression when the gap between radiographs was &gt;3.9 years. The protective effect of TNF\u03b1 inhibitors was stronger after propensity score matching.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Treatment with TNF\u03b1 inhibitors appears to reduce radiographic progression in AS patients, especially with early initiation and with longer duration of followup.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.38070","type":"journal-article","created":{"date-parts":[[2013,7,1]],"date-time":"2013-07-01T21:06:08Z","timestamp":1372712768000},"page":"2645-2654","source":"Crossref","is-referenced-by-count":447,"title":["The Impact of Tumor Necrosis Factor \u03b1 Inhibitors on Radiographic Progression in Ankylosing Spondylitis"],"prefix":"10.1002","volume":"65","author":[{"given":"Nigil","family":"Haroon","sequence":"first","affiliation":[{"name":"University Health Network and University of Toronto Toronto, Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert 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