ASAS consensus definition of early axial spondyloarthritis

Abstract

ObjectivesTo develop a consensual definition for the term ‘early axial spondyloarthritis—axSpA’—and ‘early peripheral spondyloarthritis—pSpA’.MethodsThe ASAS (Assessment of SpondyloArthritis international Society-Spondyloarthritis EARly definition) steering committee convened an international working group (WG). Five consecutive steps were followed: (1) systematic literature review (SLR); (2) discussion of SLR results within the WG and ASAS community; (3) a three-round Delphi survey inviting all ASAS members to select the items that should be considered for the definition; (4) presentation of Delphi results to the WG and ASAS community and (5) ASAS voting and endorsement (2023 annual meeting).ResultsFollowing the SLR, consensus was to proceed with an expert-based definition for early axSpA (81% in favour) but not for pSpA (54% against). Importantly, early axSpA should be based on symptom duration taking solely axial symptoms into account. 151–164 ASAS members participated in the Delphi surveys. Consensus was achieved for considering the following items within early axSpA definition: duration of symptoms ≤2 years; axial symptoms defined as cervical/thoracic/back/buttock pain or morning stiffness; regardless of the presence/absence of radiographic damage. The WG agreed that in patients with a diagnosis of axSpA ‘early axSpA’ should be defined as a duration of ≤2 years of axial symptoms. Axial symptoms should include spinal/buttock pain or morning stiffness and should be considered by a rheumatologist as related to axSpA. The ASAS community endorsed this proposal (88% in favour).ConclusionsEarly axSpA has newly been defined, based on expert consensus. This ASAS definition should be adopted in research studies addressing early axSpA.

Can rheumatologists unequivocally diagnose axial spondyloarthritis in patients with chronic back pain of less than 2 years duration? Primary outcome of the 2-year SPondyloArthritis Caught Early (SPACE) cohort

“…Finally, SPACE is unique in including patients with axial symptom duration of at most 2y, which corresponds to the recent ASAS definition of ‘early axSpA’ (for research purposes) 41. In the ASAS paper, it is stated ‘this definition is aspirational, as we know that in clinical practice there is unfortunately still a long diagnostic delay and therefore it may initially not be feasible to include patients with ≤2y of symptom duration in research studies’ 41. Our data show that it is possible to recruit patients with true early axSpA fulfilling the ASAS definition.…”

Global trends and research status in ankylosing spondylitis clinical trials: a bibliometric analysis of the last 20 years

“…Van Der Heijde is a member of the Leiden University Medical Center (LUMC), whose team focuses on research in rheumatology, particularly in the treatment of spinal arthritis. Van Der Heijde has led several clinical trials for AS ( 21 – 23 ), and has developed definitions ( 24 ), classifications ( 25 ), and guidelines for spinal arthritis ( 26 ). Van Der Heijde’s team have also validated and improved the classification criteria for axial spinal arthritis ( 27 ), helping clinicians to diagnose this disease more accurately.…”

Diagnostik und Klassifikation der axialen Spondyloarthritis (axSpA) – der aktuelle Stand

“…Grundsätzlich lässt sich unterscheiden zwischen einer sehr frühen (Symptomdauer < 2 Jahre) [11], einer frühen (< 5 Jahre) und einer Diagnose bei bereits etablierter Erkrankung (> 5 Jahre).…”