Background/Purpose: Patients can fulfil the ASAS (Assessment of SpondyloArthritiS) sets of criteria with either objective evidence of sacroiliac joint damage (X-Ray) or inflammation (MRI): (“imaging” arm) or without such imaging abnormalities in B27 patients (“clinical” arm). The clinical arm is not well recognized by the medical community and the health care systems.The aim of this study was to compare the phenotype but also the impact of the disease on the daily life of the patients with regard to the 2 different arms (e.g. “imaging” versus “clinical”) of early spondyloarthritis patients.

Methods:  Study design:  prospective, multi-centre, observational study. Patients: 708 patients with early inflammatory back pain suggestive of spondyloarthritis have been included in the DESIR cohort. Data collected: demographics, items of the ASAS criteria, disease activity, severity. Statistical analysis: The patients fulfilling the ASAS criteria were split in two groups regarding the presence of imaging (X-ray or MRI) abnormalities of the sacroiliac joints (e.g. imaging arm), and within the clinical arm, with regard to the presence of CRP abnormality (e.g. >6mg/L). 

Results:

Of the 708 recruited patients, lack of missing data permitted to classify 682 patients according to the ASAS criteria: 206 (30.2%) did not fulfill them; of the 476 (69.8%) remaining patients, 296 (60.1%) and 190 (39.9%) fulfilled the imaging and clinical arm respectively. Comparison in the patients (age, gender, B27 positivity) and disease (clinical presentation, activity and severity) characteristics fulfilling the two arms of the ASAS criteria for axial SpA showed no differences between both groups except in terms of age, gender and CRP: younger patients, more males and higher CRP values in the “imaging” arm. The multiple logistic regression analysis (by including all variables with a p<0.20 in univariated analyses) confirmed the positive association of male gender (OR 1.70 [1.12 – 2.58]) and ASDAS-CRP (OR 2.44 [1.73 – 3.44]) with the “imaging” arm.

Conclusion: This study suggests that despite some differences (e.g. gender, inflammation) the impact of the disease on daily activities were similar in both arms (e.g. imaging vs. clinical) and therefore therapeutical strategies and access to care in disabled patients should be identical regardless the arm of the ASAS criteria they are fulfilling.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/phenotype-of-patients-and-impact-of-the-disease-in-early-spondyloarthritis-are-similar-regardless-the-arm-of-the-assessment-in-spondyloarthritis-international-society-criteria-imaging/