Are the Modified New York and ASAS Criteria Interchangeable in the Classification of Patients with Spondyloarthritis with Radiographic Sacroiliitis?

Anne Boel¹, Anna Moltó ², Désirée van der Heijde ³, Adrian Ciurea ⁴, Maxime Dougados ⁵, Lianne Gensler ⁶, Maria José Santos ⁷, Eugenio de Miguel ⁸, Denis Poddubnyy ⁹, Martin Rudwaleit ¹⁰, Astrid van Tubergen ¹¹, Floris van Gaalen ³ and Sofia Ramiro ¹², ¹Leiden University Medical Centre, Leiden, Netherlands, ²Paris Descartes University, Cochin Hospital, Rheumatology department, Paris, France, ³Leiden University Medical Center, Leiden, Netherlands, ⁴University Hospital Zürich, Zürich, Switzerland, ⁵Cochin Hospital, Paris, France, ⁶University San Francisco California, San Francisco, CA, ⁷Rheumatology department, Hospital Garcia de Orta, Almada, Portugal, ⁸Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain, ⁹Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Berlin, Germany, Berlin, Germany, ¹⁰Klinikum Bielefeld, Charité Berlin, Gent University, Bielefeld, Germany, ¹¹Maastricht University Medical Centre and Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands, ¹²Leiden University Medical Center and Zuyderland Medical Centre, Leiden, Netherlands

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Ankylosing spondylitis (AS), axial spondyloarthritis, classification criteria and clinical research

Session Information

Date: Sunday, November 10, 2019

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster I: Axial Spondyloarthritis, Clinical Features

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with axial spondyloarthritis (axSpA) with radiographic sacroiliitis may be classified using the modified New York (mNY) criteria as ankylosing spondylitis and using the more recent ASAS criteria as radiographic axSpA (r-axSpA).
In both the mNY and the ASAS r‑axSpA classification sets the radiographic criterion is the same but the additionally required features differ (Table 1). The aim of this study was therefore, to investigate if patients who fulfil the mNY criteria also fulfil the ASAS criteria for r‑axSpA and vice‑versa.

Methods: Patients diagnosed with axSpA who had back pain > 3 months and definite radiographic sacroiliitis according to the mNY radiographic criterion (#4a or 4b in Table 1), were selected from eight cohorts (ASAS, Esperanza, GESPIC, OASIS, Reuma.pt, SCQM, SPACE, and UCSF axSpA cohort). Subsequently we calculated the percentage of patients who fulfil the ASAS r‑axSpA criteria within the group of patients fulfilling the mNY criteria. In six cohorts (all except Esperanza and OASIS) we were also able to calculate the percentage of patients fulfilling the mNY criteria within the group fulfilling the ASAS r-axSpA criteria.

Results: Of the 3,882 patients fulfilling the mNY criteria, 93% also fulfilled the ASAS r‑axSpA criteria (Figure 1a). Inversely, of the 3,434 patients fulfilling the ASAS r‑axSpA criteria, 96% also fulfilled the mNY criteria (Figure 1b). In total, 89% (3607/4041) of patients fulfilled both criteria sets; 7% only the mNY criteria; 3% only the ASAS criteria and 1% neither set.

The main difference between the two criteria sets was caused by reported age at onset of back pain. Out of 275 mNY+ patients not fulfilling the ASAS criteria, 265 (96%) cases were due to the age criterion and 10 (4%) due to the absence of SpA features. The 134 mNY-/ASAS+ patients did not have mobility restriction or IBP but at least one other SpA feature instead.

Conclusion: Agreement between the mNY and ASAS r‑axSpA criteria is very high, with mostly the same patients being classified according to both criteria, which supports the interchangeable use of the terms AS and r‑axSpA. This has important implications for the axSpA research field, since acknowledging that both criteria sets identify the same patients implies that older literature on AS and newer literature on r‑axSpA can be directly compared.

Table 1 Classification criteria

Table 1 Classification of patients with axial spondyloarthritis with radiographic sacroiliitis using the modified New York criteria for the classification of AS, and the ASAS criteria for the classification of radiographic axSpA.

Figure 1 Percentage of patients fulfilling ASAS r axSpA within subgroup fulfilling mNY criteria and vice-versa

Figure 1: Percentage of patients fulfilling ASAS r axSpA within subgroup fulfilling mNY criteria -3607/3882 -1a- and percentage of patients fulfilling mNY criteria within subgroup fulfilling ASAS r axSpA -3300/3434–1b-, per cohort and overall.

Disclosure: A. Boel, None; A. Moltó, None; D. van der Heijde, AbbVie, 5, AbbVie, Amgen, Astellas, AstraZeneca, BMS, 5, Amgen, 5, Astellas, 5, 9, Astellas Pharma, 5, AstraZeneca, 5, BMS, 5, Boehringer Ingelheim, 5, Boehringer Ingelheim, Celgene, Daiichi, Eli-Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB, 5, Boehringer-Ingelheim, 5, Bristol-Myers Squibb, 5, Celgene, 5, Daiichi, 5, 9, Daiichi Sankyo, 5, Director of Imaging Rheumatology, 6, Director of Imaging Rheumatology bv, 9, Eli Lilly, 5, Eli Lilly and Company, 5, Eli-Lilly, 5, Galapagos, 5, Gilead, 5, Gilead Sciences, Inc., 5, GlaxoSmithKline, 5, Glaxo-Smith-Kline, 5, GSK, 5, 8, Imaging Rheumatology bv, 9, Imaging Rheumatology BV, 9, Imaging Rheumatology bv., 9, Janssen, 5, 8, Janssen Pharmaceutica, 5, Merck, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Pfizer Inc, 5, Regeneron, 5, 8, Rheumatology bv, 4, 9, Roche, 5, 8, Sanofi, 5, 8, Takeda, 5, 8, Takeda Pharmaceutical Company, 5, UCB, 5, 8, UCB Pharma, 5; A. Ciurea, AbbVie, 5, Celgene, 5, Eli Lilly, 5, Janssen-Cilag, 5, MSD, 5, Novartis, 5, Pfizer, 5, UCB, 5; M. Dougados, AbbVie, 2, 5, 8, Amgen, 5, Biogen, 5, BMS, 2, 5, 8, Eli Lilly, 2, 5, 8, Gilead, 2, 5, Janssen, 2, 5, Merck, 2, 5, Merck Inc, 2, 5, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Pfizer Inc, 2, 5, Roche, 2, 5, 8, UCB, 2, 5, 8; L. Gensler, AbbVie, 2, 5, Abbvie, 2, 9, Amgen, 2, Amgen, AbbVie and Novartis, 2, Center for Disease Control, 8, Division of Vaccine Injury Compensation, 8, Eli Lilly, 5, 9, Eli Lilly and Company, 9, Galapagos, 5, 9, Galapagos, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, 5, Janssen, 5, 9, Novartis, 2, 5, 9, Pfizer, 2, 9, Spondylitis Association of America, 6, Spondyloarthritis Research and Treatment Network (SPARTAN), 6, UCB, 2, 5, 9, UCB Pharma, 2, 9; M. Santos, AbbVie, 8, Biogen, 8, Novartis, 8, Pfizer, 8, Roche, 8; E. de Miguel, AbbVie, 2, 5, 8, BMS, 8, BMS, MSD, UCB, Roche, 8, MSD, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 8, UCB, 8; D. Poddubnyy, Abbvie, 2, 5, 8, AbbVie, 2, 5, 8, BMS, 5, 8, Celgene, 5, 8, Eli Lilly, 5, 8, Eli Lilly and Company, 2, 5, 8, Lilly, 5, 8, MSD, 2, 5, 8, Novartis, 2, 5, 8, Pfizer, 2, 5, 8, Roche, 5, 8, UCB, 5, 8; M. Rudwaleit, Abbott, 5, AbbVie, 5, 8, BMS, 5, 8, Bristol Myers-Squibb, 5, 8, Celgene, 5, 8, Chugai, 5, 8, Eli Lilly, 5, 8, Eli Lily, 5, 8, Janssen, 5, 8, MSD, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Roche, 5, 8, UCB Pharma, 5, 8; A. van Tubergen, Abbvie, 2, Biogen, 2, Novartis, 2, 8, Pfizer, 2, UCB, 2; F. van Gaalen, None; S. Ramiro, AbbVie, 5, 8, Eli Lilly, 5, 8, Lilly, 5, 8, MSD, 2, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Sanofi, 5, 8.

To cite this abstract in AMA style:

Boel A, Moltó A, van der Heijde D, Ciurea A, Dougados M, Gensler L, Santos M, de Miguel E, Poddubnyy D, Rudwaleit M, van Tubergen A, van Gaalen F, Ramiro S. Are the Modified New York and ASAS Criteria Interchangeable in the Classification of Patients with Spondyloarthritis with Radiographic Sacroiliitis? [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/are-the-modified-new-york-and-asas-criteria-interchangeable-in-the-classification-of-patients-with-spondyloarthritis-with-radiographic-sacroiliitis/. Accessed .

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