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Objectives <p>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.</p> Methods <p>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.</p> Results <p>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%, <i>P</i> &lt; 0.001). Multivariate Cox regression analysis showed that unilateral grade II radiographic sacroiliitis and high disease activity (ASDAS-CRP &gt; 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.</p> Conclusions <p>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.</p>

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Progression of non-radiographic to radiographic axial spondyloarthritis: a risk model based on a chinese cohort study

  • 期刊论文

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  • 发表日期：

    2026年5月5日

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  • Rui-Ying Deng,
  • Xiao-Jia Xu,
  • Jian-Hua Peng,
  • Feng-Cai Shen,
  • Yao Gong,
  • Dan-Min Wang,
  • Hong-Jin Liang,
  • Shu-Xin Huang,
  • Zhao-Peng Chen,
  • Wen-Long Wu,
  • Ze-Xin Zheng,
  • Ling Lin,
  • Zhi-Duo Hou

摘要

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.