Assessment of SpondyloArthritis International Society criteria for axial spondyloarthritis in chronic back pain patients with a high prevalence of HLA–B27

Bakland, Gunnstein; Alsing, Rikke; Singh, Kuldeep; Nossent, Jiri

doi:10.1002/acr.21804

Cited by 42 publications

(29 citation statements)

References 27 publications

(37 reference statements)

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“…In line with our earlier findings among patients with Bspondylitis disease without radiographic sacroiliitis^ [12], there is a relative preponderance of women among patients with nr-axSpA as compared to those with AS [16,17]. The prevalence of HLA-B27 among axSpA patients in population-based studies varies widely depending on how such patients were ascertained [15][16][17].…”

Section: The Asas Classification Criteria Multi-arm Design Increases supporting

confidence: 66%

“…The ASAS classification criteria have been applied in several studies and settings, and the reported prevalence of axSpA has been estimated to be at least two to three times that of classical AS (by modified New York criteria) [15][16][17]. In line with our earlier findings among patients with Bspondylitis disease without radiographic sacroiliitis^ [12], there is a relative preponderance of women among patients with nr-axSpA as compared to those with AS [16,17].…”

Section: The Asas Classification Criteria Multi-arm Design Increases mentioning

confidence: 66%

“…Twenty-eight of these 332 patients (8.4 %) met the ASAS criteria for axSpA; all but one of them (96 %) were HLA-B27+. Twenty of these 28 patients (71 %) belonged to the nr-axSpA (Table 3), and 4 of them (20 %) did develop radiographic sacroiliitis after a median period of 8 years of follow-up [16]. Overall, among the 56 HLA-B27+ patients with CBP and aged 20-45, axSpA was present in 27 (48.2 %) of them.…”

Section: The Asas Classification Criteria Multi-arm Design Increases mentioning

confidence: 82%

“…A study from Tromsø, northern Norway, evaluated the utility of the ASAS criteria for axSpA in 807 patients reporting back pain lasting more than 4 weeks and who had undergone clinical, laboratory, and radiographic evaluation, but MRI was not available (Table 3) [16]. Altogether, 332 of these patients had CBP and aged 20-45 years; 163 (49 %) were males, and 56 (17.1 %) possessed HLA-B27.…”

Section: The Asas Classification Criteria Multi-arm Design Increases mentioning

confidence: 99%

“…Altogether, 332 of these patients had CBP and aged 20-45 years; 163 (49 %) were males, and 56 (17.1 %) possessed HLA-B27. The prevalence of HLA-B27 in the general population of northern Norway is 15.9 % [16]. Twenty-eight of these 332 patients (8.4 %) met the ASAS criteria for axSpA; all but one of them (96 %) were HLA-B27+.…”

Section: The Asas Classification Criteria Multi-arm Design Increases mentioning

confidence: 99%

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The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward

et al. 2015

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Classification criteria should facilitate selection of similar patients for clinical and epidemiologic studies, therapeutic trials, and research on etiopathogenesis to enable comparison of results across studies from different centers. We critically appraise the validity and performance of the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA). It is still debatable whether all patients fulfilling these criteria should be considered as having true axSpA. Patients with radiographically evident disease by the ASAS criteria are not necessarily identical with ankylosing spondylitis (AS) as classified by the modified New York criteria. The complex multi-arm selection design of the ASAS criteria induces considerable heterogeneity among patients so classified, and applying them in settings with a low prevalence of axial spondyloarthritis (SpA) greatly increases the proportion of subjects falsely classified as suffering from axial SpA. One of the unmet needs in non-radiographic form of axial SpA is to have reliable markers that can identify individuals at risk for progression to AS and thereby facilitate early intervention trials designed to prevent such progression. We suggest needed improvements of the ASAS criteria for axSpA, as all criteria sets should be regarded as dynamic concepts open to modifications or updates as our knowledge advances.

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Section: The Asas Classification Criteria Multi-arm Design Increases supporting

confidence: 66%

Section: The Asas Classification Criteria Multi-arm Design Increases mentioning

confidence: 66%

Section: The Asas Classification Criteria Multi-arm Design Increases mentioning

confidence: 82%

Section: The Asas Classification Criteria Multi-arm Design Increases mentioning

confidence: 99%

Section: The Asas Classification Criteria Multi-arm Design Increases mentioning

confidence: 99%

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The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward

et al. 2015

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Tumor Necrosis Factor α Inhibition in Radiographic and Nonradiographic Axial Spondyloarthritis: Results From a Large Observational Cohort

Ciurea

Scherer

Exer³

et al. 2013

Arthritis & Rheumatism

138

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Progression of Nonradiographic Axial Spondyloarthritis to Ankylosing Spondylitis: A Population‐Based Cohort Study

Wang

Gabriel

Ward

2016

Arthritis & Rheumatology

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Objective The long-term outcome of patients with non-radiographic axial spondyloarthritis (nr-axSpA) is unclear, particularly whether few or most progress to ankylosing spondylitis (AS). Our objective was to examine the progression to AS in a population-based inception cohort of patients with nr-axSpA. Methods The Rochester Epidemiology Project (REP) is a longstanding population-based study of health in the residents of Olmsted County, Minnesota. We searched the REP from 1985 to 2010 using diagnostic and procedural codes for back pain, HLA-B27 and pelvis magnetic resonance imaging, and performed detailed chart review to identify subjects who fulfilled the Assessment of Spondyloarthritis International Society classification criteria for axSpA but did not have AS. We followed these subjects from disease onset to March 15th, 2015, and used survival analysis to measure time to progression to AS. Results After screening 2151 patients, we identified 83 subjects with new-onset nr-axSpA. Over a mean follow-up of 10.6 years, 16 subjects progressed to AS. The probabilities of remaining as nr-axSpA at 5, 10, and 15 years were 93.6%, 82.7%, and 73.6%, respectively. Subjects in the imaging arm (n=18) progressed more frequently and rapidly than those in the clinical arm (n=65) (28% versus 17%; hazard ratio 3.50, 95% CI 1.15–10.6, p=0.02). Conclusions A minority (26%) of patients with nr-axSpA progressed to AS when followed for up to 15 years. This suggests that the classification criteria for nr-axSpA identifies many patients unlikely to progress to AS, or that nr-axSpA is a prolonged prodromal state, requiring longer follow-up to evolve to AS.

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Assessment of SpondyloArthritis International Society criteria for axial spondyloarthritis in chronic back pain patients with a high prevalence of HLA–B27

Cited by 42 publications

References 27 publications

The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward

The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward

Tumor Necrosis Factor α Inhibition in Radiographic and Nonradiographic Axial Spondyloarthritis: Results From a Large Observational Cohort

Progression of Nonradiographic Axial Spondyloarthritis to Ankylosing Spondylitis: A Population‐Based Cohort Study

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