Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose The juvenile spondyloarthropathies (JSpA) are a group of related seronegative rheumatic diseases characterized by involvement of the axial , peripheral large joints and entheses. Sets of classification have been developed in adult patients with SpA. The ASAS classification criteria for axial and peripheral SpA have not been validated in pediatric populations
Objectives:To assess the sensibility[sen] and specificity[sp] of the ASAS criteria for patients with JSpA. To compare the performance of the ASAS criteria with that of ESSG classification criteria. To identify associations between criteria fulfillment and disease features.
Methods
Consecutive patients with JSpA (defined as ERA, JPsA or UA according to ILAR) followed in our center with complete records were included. Clinical charts and databases were retrospectively reviewed. Randomly selected patients with oligoarthritis, systemic arthritis and polyarthritis RF negative served as controls. Demographic and clinical characteristics, disease duration at first visit and follow up time were recorded. Items corresponding to the ASAS, ESSG, AMOR, seronegative enthesopathy and arthropathy (SEA) syndrome and Modified New York (NY) criteria for SpA and Ankylosing Spondylitis were obtained from first visit and during disease course. Descriptive, summary statistics ([sen], [sp], positive predictive value [PPV] , negative predictive value [NPV]) and Wilcoxon Rank Sum test were used.
Results
109 patients with JSpA (104 ERA, 2 JPsA, 3UA) were included (M:93), age at onset: 10 (1-15) years, disease duration at first visit 10 (1-15) months, follow-up time 4(1-12)years. Controls: 69 patients with JIA (25 oligoarthritis, 24 polyarthritis RF negative, 20 systemic). At first visit cases showed : 106 (97%) arthritis, 89 (82%) asymetrical oligoarthritis, 69 (63%) elevated CRP, 53 (49%) limitation of lumbar spine motion, 53 (49%) HLA-B27, 46 (42%) enthesitis, 44 (40%) tarsitis, 40 (37%) low back pain (LBP), 32 (29%) good response to NSAIDS, 27 (25%) positive family history, 21 (19%) radiographic bilateral sacroiliitis grade 2-4, 14 (13%) dactylitis, 8 (7%) uveitis, 7 (6%) unilateral sacroiliitis grade 3-4, 7 (6%) diarrhea, 5 (4%) infectious previous disease, 2 (2%) urethritis, 2 (2%) inflammatory bowel disease, 2 (2%) buttock pain, 1 (1%) psoriasis. At first visit (109 patients): 81(74%) patients fulfilled ASAS criteria, 81 (74%) peripheral (p)ASAS, 80 (73%) ESSG criteria, 71 (65%) Amor, 33 (30%) SEA, 26 (24%) NY(23 definite, 3 probable), 26 (24%) axial ASAS. Disease course (102 patients): 100 (98%) fulfilled ESSG criteria, 97 (95%) ASAS, 97 (95%) pASAS, 94 (92%) Amor,75 (74%) NY (63 , 12), 42 (41%) SEA, 41 (40%) axial ASAS. ASAS sen 74%, sp 97%, PPV 97%, NPV 71%. ESSG sen 73% sp 94% PPV 95%, NPV 69 %. When tarsisis was added to the ASAS and ESSG criteria , sen increased to 82 and 84% respectively. Fulfillment of pASAS was associated with HLA-B27 (p=0,0022). Axial ASAS with LBP (p=0,00001), sacroiliitis (p=0,0007),HLA-B27 (p=0,0012).
Conclusion
In our cohort ASAS criteria performed as well as ESSG for classification of JSpA. The addition of tarsitis as a clinical criterion would improve the performance of these criteria sets
Disclosure:
M. M. Katsicas,
None;
R. A. G. Russo,
None.
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