Classification criteria and diagnosis in spondyloarthritis

2016 ◽  
Author(s):  
Stefan Siebert ◽  
Sengupta Raj ◽  
Alexander Tsoukas
Keyword(s):  
New York ◽  
Clinical Practice ◽  
Gold Standard ◽  
Axial Spondyloarthritis ◽  
Clinical Laboratory ◽  
Radiological Feature ◽  
Classification Criteria ◽  
Biologic Therapies ◽  
Radiographic Damage ◽  
Asas Criteria

The spondyloarthropathies (SpA) are heterogeneous multisystem disorders with no single ‘gold standard’ clinical, laboratory, pathological or radiological feature to confirm the diagnosis. A number of criteria have therefore been developed to support clinical practice and research. In this chapter, we highlight the important differences between classification and diagnostic criteria, which are often confused although they have very different applications. We then review some of the major SpA classification criteria including the modified New York criteria for ankylosing spondylitis (AS), the Amor and ESSG criteria for SpA, and the ASAS criteria for axial spondyloarthritis (axSpA). The evolution of these classification criteria has facilitated many significant advances in the field of axSpA and SpA in general. Specifically, the development of classification criteria for axSpA that do not rely on established radiographic damage has allowed biologic therapies to be investigated, and used, in earlier disease and for a wider population of patients.

scholarly journals Ankylosing spondylitis and axial spondyloarthritis: recent insights and impact of new classification criteria

2018 ◽  
Vol 10 (5-6) ◽  
pp. 129-139 ◽  
Author(s):  
Fabian Proft ◽  
Denis Poddubnyy
Keyword(s):  
Clinical Practice ◽  
Ankylosing Spondylitis ◽  
Early Diagnosis ◽  
Axial Spondyloarthritis ◽  
Early Stage ◽  
Classification Criteria ◽  
New Classification ◽  
The Past ◽  
Asas Classification Criteria ◽  
Recent Developments

Development of the Assessment in Spondyloarthritis International Society (ASAS) classification criteria for axial spondyloarthritis (SpA) was one of the major breakthroughs in the field over the past decade. Despite some concerns related to the specificity of the criteria, they stimulated research into the early stage of the disease. This resulted in major advances in the understanding of the course of the disease, revealing predictors of progression, improvement in early diagnosis and treatment in axial SpA. In this review, we summarize the recent developments resulting from the introduction of the ASAS classification criteria for axial SpA and the implications for research and clinical practice.

scholarly journals Non-radiographic versus radiographic axSpA: what’s in a name?

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_4) ◽  
pp. iv18-iv24
Author(s):  
Xabier Michelena ◽  
Clementina López-Medina ◽  
Helena Marzo-Ortega
Keyword(s):  
Clinical Practice ◽  
Axial Spondyloarthritis ◽  
Treatment Options ◽  
Classification Criteria ◽  
Current Evidence ◽  
Inflammatory Condition ◽  
New Bone Formation ◽  
Severe Phenotype ◽  
Clinical Presentations

Abstract Axial spondyloarthritis is a heterogeneous inflammatory condition with variable clinical presentations and outcomes. The complexity of its diagnosis and absence of biomarkers hamper the development of diagnostic criteria with the risk of misuse of the available classification criteria in clinical practice and its consequences. Axial spondyloarthritis should be regarded as a continuum in which some patients, but not all, will have a more severe phenotype characterized by progression into new bone formation and joint fusion. Growing understanding of the factors that might drive disease progression and treatment response will allow for better characterization of treatment options and outcome for each affected individual. The aim of this review is to update the current evidence of what is axial spondyloarthritis and to highlight the need to focus on the concept rather than its classification.

Prevalence of Inflammatory Back Pain and Axial Spondyloarthritis Among University Employees in Izmir, Turkey

2015 ◽  
Vol 42 (9) ◽  
pp. 1647-1651 ◽  
Author(s):  
Fatos Onen ◽  
Dilek Solmaz ◽  
Pinar Cetin ◽  
Ismail Sari ◽  
Ali Balci ◽  
...  
Keyword(s):  
Back Pain ◽  
Axial Spondyloarthritis ◽  
Age At Onset ◽  
Turkish Population ◽  
The United States ◽  
Classification Criteria ◽  
Inflammatory Back Pain ◽  
Face To Face ◽  
Asas Criteria ◽  
Asas Classification Criteria

Objective.To estimate the prevalence of inflammatory back pain (IBP) and axial spondyloarthritis (axSpA) using the Assessment of SpondyloArthritis International Society (ASAS) classification criteria among employees in a university.Methods.In the first stage of the study, a face-to-face interview was done using a standard questionnaire to investigate IBP in 381 subjects randomly selected from 2894 employees at Dokuz Eylul University in Izmir, Turkey. In the second stage, subjects with back pain for ≥ 3 months and age at onset < 45 years were evaluated for axSpA using the ASAS criteria. Both the European Spondyloarthropathy Study Group (ESSG) criteria and Amor criteria were used for the classification of the whole group of spondyloarthritis (SpA).Results.There were 131 male and 250 female subjects (mean age: 38.0 yrs). Twenty-five subjects (6.6%) were classified as having IBP according to the ASAS criteria. The prevalence of IBP according to the Berlin and Calin criteria was 7.1% and 21.5%, respectively. The prevalence of axSpA was estimated at 1.3% according to the ASAS classification criteria (0.5% for radiographic axSpA and 0.8% for nonradiographic axSpA). A total of 7 patients (1.8%) fulfilled both the Amor and ESSG criteria for the whole group of SpA.Conclusion.This is the first prevalence study of IBP and axSpA using ASAS classification criteria in the Turkish population. The prevalence estimates of IBP and axSpA reported here are within the upper range of other studies in European countries and the United States.

Remission in Nonradiographic Axial Spondyloarthritis Treated with Anti-tumor Necrosis Factor-α Drugs: An Italian Multicenter Study

2014 ◽  
Vol 42 (2) ◽  
pp. 258-263 ◽  
Author(s):  
Ennio Lubrano ◽  
Fabio Massimo Perrotta ◽  
Antonio Marchesoni ◽  
Salvatore D’Angelo ◽  
Roberta Ramonda ◽  
...  
Keyword(s):  
New York ◽  
Clinical Practice ◽  
Ankylosing Spondylitis ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Axial Spondyloarthritis ◽  
Rank Test ◽  
Tnf Α ◽  
Nonradiographic Axial Spondyloarthritis ◽  
Necrosis Factor

Objective.To investigate the possibility of achieving partial remission (PR) in patients with nonradiographic axial spondyloarthritis (nr-axSpA) versus ankylosing spondylitis (AS) treated with anti-tumor necrosis factor (TNF)-α antagonists, such as adalimumab (ADA), etanercept (ETN), and infliximab (IFX), in a real clinical practice setting. The Assessment of SpondyloArthritis international Society (ASAS) 20, ASAS40, and Ankylosing Spondylitis Disease Activity Score were also calculated.Methods.A retrospective study was conducted in patients with axSpA treated with ADA, ETN, and IFX from 2000 to 2013. All patients fulfilled the ASAS or the modified New York criteria. PR was reached when the score was < 20 mm (on a visual analog scale of 0–100 mm) in each of these domains: (1) patient global assessment, (2) pain, (3) function, and (4) inflammation.Results.A total of 321 patients with axSpA were treated. Among them, 62 were nr-axSpA while the remaining 259 were AS. Log-rank test to compare survival curves showed that the probability of obtaining PR in nr-axSpA and AS during treatment with anti-TNF-α was not significantly different. At 12 weeks of exposure to the first anti-TNF-α drug, PR was achieved in 7 patients with nr-axSpA (11.3%) and in 68 patients with AS (26.2%).Conclusion.Our results, obtained from clinical practice, showed that PR is an achievable target of anti-TNF-α treatment in nr-axSpA. The PR rate, as a reliable indicator of sustained effectiveness, is similar in nr-axSpA and in AS.

scholarly journals Do patients with axial spondyloarthritis with radiographic sacroiliitis fulfil both the modified New York criteria and the ASAS axial spondyloarthritis criteria? Results from eight cohorts

2019 ◽  
Vol 78 (11) ◽  
pp. 1545-1549 ◽  
Author(s):  
Anne Boel ◽  
Anna Molto ◽  
Désirée van der Heijde ◽  
Adrian Ciurea ◽  
Maxime Dougados ◽  
...  
Keyword(s):  
New York ◽  
Back Pain ◽  
Ankylosing Spondylitis ◽  
International Society ◽  
Axial Spondyloarthritis ◽  
Age At Onset ◽  
Complete Information ◽  
Asas Criteria ◽  
Radiographic Criterion ◽  
Almost All

BackgroundPatients with spondyloarthritis with radiographic sacroiliitis are traditionally classified according to the modified New York (mNY) criteria as ankylosing spondylitis (AS) and more recently according to the Assessment of SpondyloArthritis international Society (ASAS) criteria as radiographic axial spondyloarthritis (r-axSpA).ObjectiveTo investigate the agreement between the mNY criteria for AS and the ASAS criteria for r-axSpA and reasons for disagreement.MethodsPatients with back pain ≥3 months diagnosed as axSpA with radiographic sacroiliitis (mNY radiographic criterion) were selected from eight cohorts (ASAS, Esperanza, GESPIC, OASIS, Reuma.pt, SCQM, SPACE, UCSF). Subsequently, we calculated the percentage of patients who fulfilled the ASAS r-axSpA criteria within the group of patients who fulfilled the mNY criteria and vice versa in six cohorts with complete information.ResultsOf the 3882 patients fulfilling the mNY criteria, 93% also fulfilled the ASAS r-axSpA criteria. Inversely, of the 3434 patients fulfilling the ASAS r-axSpA criteria, 96% also fulfilled the mNY criteria. The main cause for discrepancy between the two criteria sets was the reported age at onset of back pain.ConclusionAlmost all patients with axSpA with radiographic sacroiliitis fulfil both ASAS and mNY criteria, which supports the interchangeable use of the terms AS and r-axSpA.

Classification and Diagnosis of Axial Spondyloarthritis — What Is the Clinically Relevant Difference?

2014 ◽  
Vol 42 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Jurgen Braun ◽  
Xenofon Baraliakos ◽  
Uta Kiltz ◽  
Frank Heldmann ◽  
Joachim Sieper
Keyword(s):  
New York ◽  
Clinical Features ◽  
False Positive ◽  
Axial Spondyloarthritis ◽  
False Negative ◽  
Classification Criteria ◽  
Asas Classification Criteria ◽  
Tertiary Center ◽  
Incorrect Diagnosis ◽  
Positive Results

Objective.The Assessment of Spondyloarthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA) have added nonradiographic axSpA (nr-axSpA) to the classic ankylosing spondylitis (AS) as defined by the modified New York criteria. However, some confusion remains about differences between classification and diagnosis of axSpA. Our objective was to analyze differences between classification and diagnostic criteria by discussing each feature of the classification criteria based on real cases.Methods.The clinical features of the ASAS classification criteria were evaluated in relation to their significance for an expert diagnosis of axSpA. Twenty cases referred to our tertiary center outpatient clinic were selected because of an incorrect diagnosis of axSpA: 10 cases in which axSpA had been excluded initially because the classification criteria were not fulfilled, and 10 patients who had been previously diagnosed with axSpA because the classification criteria were fulfilled. Upon reevaluation, the former were diagnosed with axSpA while the latter had other diseases.Results.All items that are part of the classification criteria show some variability related to their relevance for a diagnosis of axSpA. There are clinical features suggestive of axSpA that are not part of the classification criteria. Misinterpretation of imaging procedures contributed to false-positive results. Rarely, other diseases may mimic axSpA.Conclusion.Because the sensitivity and specificity of the axSpA classification criteria have been around 80% in clinical trials, some false-positive and false-negative cases were expected. It is hoped that their detailed description and discussion will help to increase the understanding of diagnosing axSpA in relation to the ASAS classification criteria.

scholarly journals OP0255 THE ROLE OF PELVIC MORPHOLOGY IN AXIAL SPONDYLOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 156.1-156
Author(s):  
E. Zaccagnino ◽  
R. Patel ◽  
L. S. Gensler
Keyword(s):  
New York ◽  
Ankylosing Spondylitis ◽  
Axial Spondyloarthritis ◽  
Axial Skeleton ◽  
Chronic Inflammatory Disease ◽  
Cross Sectional ◽  
Radiographic Damage ◽  
Pelvic Morphology ◽  
The Relationship

Background:Axial Spondyloarthritis (axSpA) is a chronic inflammatory disease affecting the axial skeleton. It includes non-radiographic axSpA and radiographic axSpA [Ankylosing Spondylitis (AS)]. Male axSpA patients often have greater damage, while women report a higher disease burden. The role of pelvic morphology in the axSpA phenotype has not been explored. There is anatomic sexual dimorphism between the male and female pelvis. Given the phenotypic gender differences in axSpA, the role of pelvic morphometry is of interest.Objectives:The purpose of this study is to determine whether an association exists between pelvic dimensions and radiographic damage in patients with axSpA, as well as to compare these measurements in axSpA patients and healthy controls.Methods:This was a cross-sectional analysis comparing axSpA cases from a prospective cohort and non-axSpA controls from the UCSF radiology databank. Informed consent was obtained from axSpA cohort patients and this study was approved by the institutional IRB. To be included in the analysis, we limited inclusion to age ≤ 50 with an Anterior Posterior (AP) pelvis radiograph in the system. We excluded non-nulliparity, pelvic fracture history, BMI ≥ 30kg/m2, any prosthetic history and avascular necrosis. We measured the pelvic inlet, pelvic outlet, and subpubic angle (based on validated scoring methods) (Figure 1) and assessed its relation to sacroiliac joint (SIJ) damage (average SIJ score, New York criteria) and modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) in cases. AxSpA patients were also compared to age/gender matched controls. Pelvic measurements were performed by 2 blinded independent-trained readers in randomized, blinded image order. Inter-rater reliability was assessed. When examining the relationship between pelvic measurements and damage, linear regression was used to stratify by gender and adjust for potential confounders.Results:The axSpA cohort included 481 patients, of which 210 men and 89 women were included in this analysis and gender/age matched controls. Rater inter-class correlation was above 0.70 for pelvic outlet and above 0.80 for other measures. Cases and controls were similar (Table 1). The regression analysis showed a significant relationship between the sub-pubic angle and damage in the spine (coeff=-0.342, p=0.003) in men with axSpA. A sensitivity analysis, excluding mSASSS outliers (mSASSS ≥ 16) upheld the relationship (coeff=-1.40, p=0.002).Conclusion:In men with axSpA, there appears to be a relationship between sub-pubic angle and spinal radiographic damage. This is consistent with our finding that women have larger sub-pubic angles and lower spinal radiographic damage than men. A greater sub-pubic angle may protect against spinal involvement or associate with other protective factors. Further work should be performed to understand the contribution of pelvic anatomy to damage in axSpA.Disclosure of Interests:Ethan Zaccagnino: None declared, Rina Patel: None declared, Lianne S. Gensler Consultant of: AbbVie, Eli Lilly, Gilead, Novartis, Pfizer and UCB., Grant/research support from: Pfizer and UCB.

SAT0392 DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS IN DAILY CLINICAL PRACTICE – A SURVEY AMONG DUTCH RHEUMATOLOGISTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1145.1-1145
Author(s):  
A. Spoorenberg ◽  
S. Arends ◽  
M. Sinnige ◽  
M. De Hair
Keyword(s):  
Clinical Practice ◽  
The Netherlands ◽  
Axial Spondyloarthritis ◽  
Classification Criteria ◽  
Daily Clinical Practice ◽  
Symptom Duration ◽  
Research Support ◽  
Early Referral ◽  
Face To Face ◽  
Asas Classification Criteria

Background:Since publication of the ASAS classification criteria for axial spondyloarthritis (axSpA) in 20091and the development of ASAS-endorsed recommendation for early referral of patients with a suspicion of axSpA,2awareness for non-radiographic (nr-) axSpA besides Ankylosing Spondylitis (AS) has increased. Still there is limited information of how nr-AxSpA is addressed in daily clinical practice.Objectives:To get insight into the diagnostic phase of axSpA in daily rheumatologic practice in the Netherlands, and to explore if nr-axSpA is addressed differently from AS.Methods:We set up a 21 multiple choice question survey for rheumatologists in the Netherlands with 5 general questions about their practice and 16 questions addressing the diagnostic phase of axSpA. The questionnaire was taken by representatives of the medical department of Novartis NL during structured face-to-face interviews. Rheumatologists in the Netherlands were invited to participate, aiming to get a sample of rheumatologists varying in geographical location and hospital type, as well as a mix of SpA-experts and non-SpA-experts. Rheumatologists gave approval for anonymous use of the data, which were entered in a database and subsequently analyzed using descriptive statistics.Results:From October 15th2019 until January 16th2020, 36 Dutch rheumatologists participated in the face-to-face survey; 6 from university hospitals, 27 from general hospitals and 3 from private care centers. Most of axSpA patients (61%) were referred by the general practitioner and mean time between referral and first visit was 2-6 weeks. More than 50% of rheumatologists reported a mean symptom duration of >1 year and in 30% even >2 years before first visit. For diagnosing axSpA rheumatologists performed in almost all cases X-pelvis (mean 100% (SD 0%) for both AS and nr-axSpA), CRP/ESR (91% (26%) for AS; 94% (22%) for nr-axSpA) and HLA-B27 (74% (40%) for AS; 86% (26%) for nr-axSpA. MRI of the SI joints was performed in 31% and 82% of patients, respectively, and about 60% of the rheumatologists used of classification criteria for diagnosing axSpA. In addition, rheumatologists marked the level of importance of several (SpA) clinical features for making the diagnosis AS or nr-axSpA (Figure 1). Most rheumatologists graded inflammatory back pain, arthritis/enthesitis/dactylits and uveitis as very important for contributing to the diagnosis. Functional impairment of the spine and male sex were mostly graded neutral or not important for making a diagnosis of axSpA. All features were graded of similar importance for the diagnosis AS and nr-axSpA, except for backpain starting before the age of 45, which was considered more important for diagnosing AS.Conclusion:This survey among Dutch rheumatologists showed that in 30% of patients referred with possible suspicion of axSpA, symptom duration still was >2 years. Almost 60% of rheumatologists make use of the ASAS classification criteria for diagnosing nr-axSpA. Therefore, for early referral awareness of axSpA in first line should enhance. Furthermore, rheumatologists should become aware that classification criteria are not similar to diagnostic criteria and cannot be used as a tick box for diagnosis.References:[1]Rudwaleit M et al, Ann Rheum Dis 2009;68:777-83, 2. Poddubnyy D et al, Ann Rheum Dis 2015;74:1483–7Acknowledgments:We would like to thank all participating rheumatologists.Disclosure of Interests:Anneke Spoorenberg: None declared, Suzanne Arends Grant/research support from: Grant/research support from Pfizer, Mark Sinnige Employee of: Current employee of Novartis Pharma B.V., Marjolein de Hair Employee of: Current employee of Novartis Pharma B.V.

scholarly journals Indonesian Rheumatology Association (IRA) Recommendations for Diagnosis and Management of Axial Spondyloarthritis 2021

2021 ◽  
Vol 13 (1) ◽  
pp. 444-458
Author(s):  
Ayu Paramaiswari ◽  
R.M. Suryo Anggoro Kusumo Wibowo ◽  
Yulyani Werdiningsih ◽  
Arief Nurudhin ◽  
Surya Darma ◽  
...  
Keyword(s):  
New York ◽  
Disease Activity ◽  
Therapeutic Response ◽  
Axial Spondyloarthritis ◽  
Sacroiliac Joints ◽  
Levels Of Evidence ◽  
Literature Searches ◽  
Asas Criteria ◽  
The Us ◽  
Level Of Agreement

Objective. Recommendations for spondyloarthritis are made to provide guidelines in diagnosis establishment, therapy, and monitoring of axial spondyloarthritis cases.Method. Literature searches were conducted online. The drafting team determines the levels of evidence (LOE) and grades of recommendation (GOR). After conducting a discussion, each recommendation that has been agreed upon by the drafting team is then classified based on the levels of evidence and grades of recommendation. The final step in the preparation of these recommendations is to determine the level of agreement (LOA) on each recommendation carried out by a team of panelists who have been appointed by IRA.Results. Twenty recommendations regarding axial spondyloarthritis were established. Strong recommendations or GOR A include: Ax-SpA diagnosis can be made according to the 2010 ASAS criteria, or the 1984 modified New York criteria specifically for the US; conventional radiographic examinations and MRI of the sacroiliac joints and vertebrae may be used as evaluators of disease activity and predictors of therapeutic response, as well as patients who do not respond to NSAIDs (within 4 weeks) can be administered a combination of NSAIDs and anti-TNF, and if it is not possible, a combination of NSAIDs and anti-IL-17A (Secukinumab, Ixekizumab).Conclusion. These recommendations provide a direction for clinicians to diagnose and manage spondyloarthritis.

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