Session Information
Title: Spondylarthropathies and Psoriatic Arthritis - Clinical Aspects and Treatment: Spondyloarthritis II
Session Type: Abstract Submissions (ACR)
Background/Purpose: To validate the new axial and peripheral ASAS criteria in patients with early spondyloarthritis (SpA) and the full spectrum of clinical manifestations under clinical practice conditions.
OBJECTIVES: 1) To analyze the validity of the ASAS classification criteria for SpA in an early multisite cohort; 2) to describe the characteristics of the new-onset SpA cohort from the ESPERANZA program and 3) to analyze the positive and negative predictive value of the ASAS, Amor, and ESSG criteria in this cohort.
Methods: Cross-sectional study of all patients with new-onset SpA referred to units within the ESPERANZA program. Selection criteria for the program are: Patients under 45 years of age with, at least, one of the follow: a) a two-year history of inflammatory back pain; b) back or joint pain in the presence of psoriasis, anterior uveitis, radiographic sacroiliitis, family history of SpA or positive HLA-B27; or c) asymmetric arthritis. A validation analysis of criteria sets was performed with the rheumatologist opinion as gold standard. We excluded patients who did not meet the referral criteria and those in which the radiograph on HLA-B27 were not available. The predictive ability of individual criteria was analyzed versus the physician’s opinion, thus only patients with a diagnosis could be included.
Results:
1179 patients were included for Esperanza program, but only 775 met inclusion criteria. Low-back pain was the primary reason for referral (73.7%). The mean age of the sample was 33.1 ± 7.1 years and 55.4% were men. The mean time from symptoms was less than a year (11.9 ± 6.6 months). A percentage of 69.5% (538) of patients were diagnosed with SpA, and 30.5% (237) were diagnosed with No SpA. The most frequent joint manifestations in patients with SpA were inflammatory back pain (67.5%) and the presence of peripheral arthritis (18%); the prevalence of HLA-B27 in this population was 55.6%, and the most frequent extra-articular manifestation was psoriasis (13.9%). A total of 67.9% patients with chronic back pain met the ASAS axial criteria, peripheral ASAS in 56.3% (without chronic back pain) and full ASAS in 65.1%. Sensitivity and specificity of the full ASAS criteria set was 65% and 93%, a little higher or axial ASAS, 68% sensitivity and 95% specificity; and for peripheral ASAS, 56% and 85%, respectively. Sensitivity and specificity for ESSG criteria, and Amor criteria are presented in Table 1.
Table 1. Results of the validation analysis and predictive ability (N = 775)
|
Criteria |
Sensitivity (CI 95%) |
Specificity (CI 95%) |
Positive predictive value (CI 95%) |
Negative predictive value (CI 95%) |
|
ASAS axial |
68 (63, 73) |
95 (91, 98) |
97 (94, 98) |
58 (53, 64) |
|
ASAS axial-imaging |
43 (38, 48) |
98 (95, 99) |
98 (94, 99) |
45 (40, 50) |
|
ASAS axial-HLA B27 |
50 (45, 55) |
96 (93, 99) |
97 (93, 99) |
48 (43, 53) |
|
ASAS peripheral |
56 (48, 65) |
85 (71, 94) |
92 (83, 97) |
40 (30, 50) |
|
ASAS total |
65 (61, 69) |
93 (89, 96) |
95 (93, 97) |
54 (49, 59) |
|
ESSG |
58 (54, 62) |
90 (86, 94) |
93 (90, 96) |
49 (44, 53) |
|
Amor |
59 (55, 63) |
86 (81, 90) |
90 (87, 93) |
48 (43, 53) |
Conclusion:
The sensitivity and specificity of the ASAS criteria are higher than the ESSG and Amor criteria, so in early SpA forms the ASAS criteria may replace both criteria. However, the sensitivity for the ASAS criteria in this new-onset SpA is lower than in previous studies, what may limit their ability to detect early forms, particularly in populations in which MRI is not available under standard clinical practice or in population with a low prevalence of HLA-B27.
Disclosure:
E. Tomero,
None;
L. Carmona,
Abbott Laboratories,
5,
Roche Pharmaceuticals,
2,
Tigenix,
5;
J. Mulero,
None;
E. De Miguel,
None;
M. Gobbo,
None;
C. Martínez,
None;
M. A. Descalzo,
None;
P. Zarco,
None;
E. Collantes-Estevez,
None;
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