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Ann Rheum Dis. 2005 January; 64(1): 127–129.
Published online 2004 March 29. doi:  10.1136/ard.2004.020503
PMCID: PMC1755183

Assessment of outcome in ankylosing spondylitis: an extended radiographic scoring system


Methods: The Stoke Ankylosing Spondylitis Spinal Score (SASSS) was modified by adding a score for the cervical spine and defining squaring. This modified SASSS (mSASSS) is the sum of the lumbar and cervical spine score (range 0–72). 370 lateral views of the lumbar and cervical spine were used for development of the mSASSS, standardisation of observers, and for studying reliability. In a 48 week NSAID study of 57 patients, change over time and construct validity were studied.

Results: Interobserver correlations of the lumbar and cervical spine scores were good (r>0.95). The interobserver duplicate error was 0.55 in a range from 0 to 36. The mean change in the cervical and lumbar spine scores between weeks 0 and 48 of all patients was 1.45 (range 0–6.0) and 1.06 (0–5.0), respectively (paired t testing, p<0.001). Change in radiological score was seen in 36/57 (63%) patients (lumbar and cervical spine 11, cervical spine 12, lumbar spine 13 patients).

Conclusion: The mSASSS is useful for assessing extensive radiographic damage in AS. It is reliable, detects changes over 48 weeks, and shows a satisfactory face and construct validity.

Figure 1
 Radiographic changes from weeks 0 to 48 for all patients, men and women separately. CSW, cervical spine women; CSM, cervical spine men; LSW, lumbar spine women; LSM, lumbar spine men; mSASSS, modified Stoke Ankylosing Spondylitis Score in all ...

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