Abstract
BackgroundIn this study, we sought to compare the performance of spondyloarthritis (SpA) classification criteria sets in an international SpA cohort with patients included from five continents around the world.MethodsData from the (ASAS) COMOrbidities in SPondyloArthritis (ASAS-COMOSPA) study were used. ASAS-COMOSPA is a multinational, cross-sectional study with consecutive patients diagnosed with SpA by rheumatologists worldwide. Patients were classified according to the European Spondyloarthropathy Study Group (ESSG), modified European Spondyloarthropathy Study Group (mESSG), Amor, modified Amor, Assessment of SpondyloArthritis international Society (ASAS) axial Spondyloarthritis (axSpA), ASAS peripheral spondyloarthritis (pSpA) and ClASsification criteria for Psoriatic Arthritis (CASPAR) criteria. Overlap between the classification criteria sets was assessed for patients with and without back pain. Furthermore, patients fulfilling different arms of the ASAS axSpA criteria (imaging arm, clinical arm, both arms) were compared on the presence of SpA features.ResultsA total of 3942 patients (5 continents, 26 countries) were included. The mean age was 43.6 years, 65.0% were male, 56.2% were human leucocyte antigen B27-positive and 64.4% had radiographic sacroiliitis (based on modified New York criteria). Of the patients, 85.5% were classified by the ASAS SpA criteria (87.7% ASAS axSpA, 12.3% ASAS pSpA). Fulfilment of the Amor, ESSG and CASPAR criteria was present in 83.3%, 88.4% and 21.6% of patients, respectively. Of the patients with back pain (n = 3227), most were classified by all three of Amor, ESSG and ASAS axSpA criteria (71.4%). Patients fulfilling the imaging arm and the clinical arm of the ASAS axSpA criteria had similar presentations of SpA features. In patients without back pain, overlap between classification criteria sets was seen, although to a lesser extent.ConclusionsMost patients with a clinical diagnosis of axial SpA in the worldwide ASAS-COMOSPA study fulfil several classification criteria sets, and a substantial overlap between different criteria sets is seen, which suggests a high level of credibility of the criteria. Large inter-regional differences in the fulfilment of classification criteria were not found. Patients fulfilling the clinical arm were remarkably similar to patients fulfilling the imaging arm with respect to the presence of most SpA features.
Highlights
In this study, we sought to compare the performance of spondyloarthritis (SpA) classification criteria sets in an international SpA cohort with patients included from five continents around the world
We investigated the possibility of including inflammatory findings on magnetic resonance imaging (MRI) (ASAS definition [9]) as a feature in both the ESSG and modified European Spondyloarthropathy Study Group (mESSG) Modified European Spondyloarthropathy Study Assessment of SpondyloArthritis international Society (ASAS) Assessment of SpondyloArthritis international axial Spondyloarthritis (axSpA) Axial spondyloarthritis (Society) (Group) (Amor) criteria, resulting in the modified Amor and modified European Spondyloarthropathy Study Group criteria
Most patients diagnosed with SpA by rheumatologists in five continents across the world fulfilled multiple classification criteria sets
Summary
We sought to compare the performance of spondyloarthritis (SpA) classification criteria sets in an international SpA cohort with patients included from five continents around the world. Classification serves a completely different purpose, and several classification criteria sets of SpA are available. These classification criteria should be applied only in patients who have been diagnosed with SpA by a rheumatologist, and they cannot be used as a check box to be ticked in order to make the diagnosis. We do not know which sets have influenced clinicians in particular regions most or to what extent these various sets of criteria describe more or less similar patients. We do not know if rheumatologists around the world diagnose patients with a similar clinical picture of the disease
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