The assessment of the spondyloarthritis international society concept and criteria for the classification of axial spondyloarthritis and peripheral spondyloarthritis: A critical appraisal for the pediatric rheumatologist

Burgos‐Vargas, Rubén

doi:10.1186/1546-0096-10-14

Cited by 59 publications

(29 citation statements)

References 55 publications

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“…Juvenile-onset AS differs in the first symptoms, the clinical picture, the frequency of manifestations at onset and severity in course of disease from adult-onset AS. [1][2][3][4] The International League of Associations for Rheumatology (ILAR) developed classification criteria for juvenile idiopathic arthritis ( JIA). 5 Within the JIA classification criteria, jSpA was not considered as one disease entity.…”

Section: Introductionmentioning

confidence: 99%

Course of patients with juvenile spondyloarthritis during 4 years of observation, juvenile part of GESPIC

et al. 2017

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ObjectiveTo describe the course and the 4-year outcome of juvenile spondyloarthritis (jSpA).MethodsPatients with a diagnosis of jSpA and an age at onset ≤16 years were included in the German Spondyloarthritis Inception cohort (GESPIC) and followed up prospectively for 4 years.Results118 patients (73% men, 66% HLA-B27 positive, mean age 13.5 years, mean symptom duration 2.2 years) were enrolled in 2 study centres: 52% of patients with jSpA were captured by the enthesitis-related arthritis subgroup of the International League of Associations for Rheumatology classification criteria. At inclusion, the majority of patients had active peripheral arthritis (75.4%), followed by inflammatory back pain (IBP) (19.5%) and enthesitis (16.1%). There was a significant improvement in clinical manifestations and in patient-reported outcomes over time. During the 4-year follow-up, 85% of the patients had at least 1 period of remission on drug ≥6 months, and 46% of the patients achieved remission ≥12 months without medication, of whom 68% kept this status and 32% worsened. At the end of 4 years of observation, 23% of the patients were in remission without medication, but 57% still suffered from active disease. Patients with peripheral arthritis had a likelihood of 29% for having peripheral arthritis after 4 years, whereas the likelihood of IBP persistence was 53% for those with IBP at enrolment.ConclusionsAlthough 1 quarter of patients with jSpA achieved remission off medication after 4 years, the likelihood of having recurrent or persistent disease into adulthood is substantial, particularly for jSpA with IBP.Trial registration numberNCT 01277419.

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Section: Introductionmentioning

confidence: 99%

Course of patients with juvenile spondyloarthritis during 4 years of observation, juvenile part of GESPIC

et al. 2017

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“…AS in adults exists as an extension of the juvenile SpA. They are not separate diseases, but instead represent diseases on the same continuum [31]. Therefore, diagnostic criteria involving both pediatric and adult patients are necessary for detecting patients who may progress to AS at an earlier stage.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several reviews have noted that the ASAS criteria for adult AS are effective for diagnosing juvenile SpA patients early [7,31]. The ASAS criteria categorize not only axial spondyloarthritis but also peripheral spondyloarthritis, which make it easier to detect juvenile patients with SpA whose manifestations primarily consist of peripheral symptoms.…”

Section: Discussionmentioning

confidence: 99%

Human Leukocyte Antigen B27 and Juvenile Idiopathic Arthritis and Classification of Juvenile Spondyloarthropathies by the Assessment of SpondyloArthritis International Society Criteria

2016

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Objective. We examined the clinical relationship between human leukocyte antigen B27 (HLA-B27) and juvenile idiopathic arthritis (JIA). Additionally, we assessed the usefulness of the Assessment of SpondyloArthritis International Society (ASAS) criteria for diagnosing juvenile spondyloarthropathies (SpA). Methods. We retrospectively reviewed medical records of 239 patients with JIA classified according to the International League of Associations for Rheumatology (ILAR) classification to analyze the features of the joint involvement site. Results were correlated with the presence of HLA-B27. After that, we classified the 239 JIA patients according to the ASAS criteria to diagnose juvenile SpA. The relationship between the ASAS criteria and a diagnosis of juvenile SpA was analyzed by a chi-squared test. Results. Back pain was associated with HLA-B27 in boys (p=0.002) but not in girls (p=0.616). In both sexes, involvement of the small joints in the lower extremities was highly associated with HLA-B27 (p=0.001 for boys, p=0.021 for girls). In addition, HLA-B27 was associated with enthesitis (p=0.004 for boys, p=0.021 for girls). Eighty-seven (36.4%) patients with JIA fulfilled the ASAS criteria; 2 (0.8%) had axial SpA and 85 (35.6%) had peripheral SpA. HLA-B27 was the most significant factor for diagnosing juvenile SpA (sensitivity 80%, specificity 99.31%, positive likelihood ratio, 116). Conclusion. The ILAR criteria have some weaknesses for diagnosing HLA-B27-positive JIA patients in early stages. The use of the ASAS criteria for juvenile patients will enable pediatric rheumatologists to diagnose juvenile SpA patients earlier.

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“…A comparison of subtypes between the ILAR classification and the new provisional classification for JIA is shown in Figure 1. We also applied the Assessment of the SpondyloArthritis International Society (ASAS) criteria for adult SpA to JIA patients [28]. Patients were diagnosed and classified by a skilled pediatric rheumatologist, and excluded if they were followed up for less than 6 months.…”

Section: Patientsmentioning

confidence: 99%

New Provisional Classification of Juvenile Idiopathic Arthritis Applying Rheumatoid Factor and Antinuclear Antibody

2018

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Objective. Previous classification systems for juvenile idiopathic arthritis (JIA) were based on the number of joints involved and did not categorize homogenous disease entities. Therefore, JIA patients were reclassified retrospectively by applying rheumatoid factor (RF) and antinuclear antibody (ANA), which have been proven to constitute a homogenous disease entity. Methods. The medical records of JIA patients were investigated retrospectively and reclassified into six categories using the new provisional classification. The nomenclature was based on Dr. Martini's proposal in the 23rd European Paediatric Rheumatology Congress (2016) at Genoa, Italy. New categories included systemic JIA (sJIA), RF-positive JIA (RF-JIA), early-onset ANA-positive JIA (eoANA-JIA), enthesitis/spondylitis-related JIA (ESR-JIA), "other JIA", and "unclassified JIA". Results. Of a total of 262 JIA patients, 71 (27.1%) were reclassified as sJIA, 31 (11.8%) as RF-JIA, 22 (8.4%) as eoANA-JIA, 63 (24.0%) as ESR-JIA, 65 (24.8%) as "other JIA", and 10 (3.8%) as "unclassified JIA". A comparison of RF-JIA, eoANA-JIA, and ESR-JIA revealed significant differences in the gender ratio, age of disease onset, and the cumulative number and type of joints involved among the three groups. "Other JIA" comprised a significant proportion (24.8%) and warrants the need for further classification. The characteristics of the RF-positive patients were comparable to those of the anti-cyclic citrullinated peptide antibody-positive patients. The ANA positivity was lower (28.2%) than that in Western studies but showed similar clinical features. Conclusion. This is the first study applying RF and ANA to classify JIA without considering the joint counts. The six new categories include sJIA, RF-JIA, eoANA-JIA, ESR-JIA, "other JIA," and "unclassified JIA". (J Rheum Dis 2018;25:34-46)

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The assessment of the spondyloarthritis international society concept and criteria for the classification of axial spondyloarthritis and peripheral spondyloarthritis: A critical appraisal for the pediatric rheumatologist

Cited by 59 publications

References 55 publications

Course of patients with juvenile spondyloarthritis during 4 years of observation, juvenile part of GESPIC

Course of patients with juvenile spondyloarthritis during 4 years of observation, juvenile part of GESPIC

Human Leukocyte Antigen B27 and Juvenile Idiopathic Arthritis and Classification of Juvenile Spondyloarthropathies by the Assessment of SpondyloArthritis International Society Criteria

New Provisional Classification of Juvenile Idiopathic Arthritis Applying Rheumatoid Factor and Antinuclear Antibody

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