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

Ann Rheum Dis. 2005 Jan;64(1):127-9. doi: 10.1136/ard.2004.020503. Epub 2004 Mar 29.


Objective: To develop and validate an extensive radiographic scoring system for ankylosing spondylitis (AS).

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.

Publication types

  • Validation Study

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Cervical Vertebrae / diagnostic imaging
  • Female
  • Humans
  • Lumbar Vertebrae / diagnostic imaging
  • Male
  • Observer Variation
  • Radiography
  • Reproducibility of Results
  • Severity of Illness Index*
  • Spondylitis, Ankylosing / diagnostic imaging*
  • Spondylitis, Ankylosing / drug therapy
  • Treatment Outcome


  • Anti-Inflammatory Agents, Non-Steroidal