Staging of patients with ankylosing spondylitis: a preliminary proposal

Abstract

Patients with ankylosing spondylitis (AS) are characterised by a wide range of clinical presentations, radiographic profiles, and outcomes, which are not well differentiated by current diagnostic and classification systems for the disorder. Inadequacies in these systems may limit clinicians' ability to manage their patients with AS appropriately and act as an obstacle to reasonable comparison of therapeutic trial results. A standardised staging system for AS is therefore proposed that would provide a more detailed categorisation of patients based on assessment of structural damage, peripheral joint and organ involvement, presence of concomitant diseases, and the severity and extent of disease activity and functional impairment. The proposed system needs to be evaluated closely and amended as needed to assure its usefulness in clinical and research settings.

Efficacy of etanercept on rheumatic signs and pulmonary function tests in advanced ankylosing spondylitis: results of a randomised double-blind placebo-controlled study (SPINE)

“…On the basis of the personal experience of the scientific committee in charge of the design of the protocol, the presence of intervertebral adjacent bridges (at least two at the lumbar or cervical spine level or three at the thoracic level) was considered advanced disease. A post hoc analysis of data collected by the local investigator allowed for categorising disease according to the radiological grade scale from I to IV 15. Moreover, the mean mSASSS score we observed at baseline in the modified intent-to-treat population (36.5±20.5) was higher than the score from ‘conventional’ studies evaluating the structural effect of TNF blockers (16±18, 18±18, 20±19 in the ETN,28 infliximab29 and adalimumab30 trials, respectively).…”

Analysis of Clinical Indexes andRUNX3,TBKBP1,PPARGC1BPolymorphisms in Chinese Han Patients with Ankylosing Spondylitis

“…Changes in the spine involve syndesmophytes forming bony ankylosis of adjacent vertebrae or ankylosis of small vertebral joints. Some classification systems exist based on clinical and radiographic criteria (Taylor et al, 1998;Braun et al, 2002). Most of our patients present with mild symptoms and do well with chronic medical treatments; however, some patients have more severe manifestations that require surgery within the first 10 years of diagnosis.…”

Mapping the relationship between clinical and quality-of-life outcomes in patients with ankylosing spondylitis

“…Overall work impairment was assessed only in patients who were working (not in patients who were invalid 3 and not working, on maternal leave and not working, or on pension); activity impairment 1 In short, Stage I: Grade II or higher bilateral radiographic sacroiliitis; Stage II: minor radiographic evidence of spinal involvement; Stage III: moderate radiographic evidence of spinal involvement; Stage IV: radiographic evidence of spinal involvement; Stage V: Widespread fusion of the spine [32]. 2 Impairment of leisure time activities is in the WPAI questionnaire labelled as "activity impairment due to problem", henceforth and throughout the text only activity impairment.…”

“…AS stages were assessed according to Braun et al radiographic grading [32]. 1 Clinical data were assessed using the Ankylosing Spondylitis Disease Activity Score with the C-reactive protein measure (ASDAS-CRP) and the Bath Ankylosing Spondylitis Functional Index (BASFI, using a 0-10 scale) [11,12].…”