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The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal.
Ann Rheum Dis 2009; 68(6):770-6AR

Abstract

OBJECTIVE

Non-radiographic axial spondyloarthritis (SpA) is characterised by a lack of definitive radiographic sacroiliitis and is considered an early stage of ankylosing spondylitis. The objective of this study was to develop candidate classification criteria for axial SpA that include patients with but also without radiographic sacroiliitis.

METHODS

Seventy-one patients with possible axial SpA, most of whom were lacking definite radiographic sacroiliitis, were reviewed as "paper patients" by 20 experts from the Assessment of SpondyloArthritis international Society (ASAS). Unequivocally classifiable patients were identified based on the aggregate expert opinion in conjunction with the expert-reported level of certainty of their judgement. Draft criteria for axial SpA were formulated and tested using classifiable patients.

RESULTS

Active sacroiliitis on magnetic resonance imaging (MRI) (odds ratio 45, 95% CI 5.3 to 383; p<0.001) was strongly associated with the classification of axial SpA. The knowledge of MRI findings led to a change in the classification of 21.1% of patients. According to the first set of candidate criteria (sensitivity 97.1%; specificity 94.7%) a patient with chronic back pain is classified as axial SpA in the presence of sacroiliitis by MRI or x rays in conjunction with one SpA feature or, if sacroilitiis is absent, in the presence of at least three SpA features. In a second set of candidate criteria, inflammatory back pain is obligatory in the clinical arm (sensitivity 86.1%; specificity 94.7%).

CONCLUSION

The ASAS group has developed candidate criteria for the classification of axial SpA that include patients without radiographic sacroiliitis. The candidate criteria need to be validated in an independent international study.

Authors+Show Affiliations

Med Klinik I, Charité, Campus Benjamin Franklin, Berlin, Germany. martin.rudwaleit@charite.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19297345

Citation

Rudwaleit, M, et al. "The Development of Assessment of SpondyloArthritis International Society Classification Criteria for Axial Spondyloarthritis (part I): Classification of Paper Patients By Expert Opinion Including Uncertainty Appraisal." Annals of the Rheumatic Diseases, vol. 68, no. 6, 2009, pp. 770-6.
Rudwaleit M, Landewé R, van der Heijde D, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009;68(6):770-6.
Rudwaleit, M., Landewé, R., van der Heijde, D., Listing, J., Brandt, J., Braun, J., ... Sieper, J. (2009). The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Annals of the Rheumatic Diseases, 68(6), pp. 770-6. doi:10.1136/ard.2009.108217.
Rudwaleit M, et al. The Development of Assessment of SpondyloArthritis International Society Classification Criteria for Axial Spondyloarthritis (part I): Classification of Paper Patients By Expert Opinion Including Uncertainty Appraisal. Ann Rheum Dis. 2009;68(6):770-6. PubMed PMID: 19297345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. AU - Rudwaleit,M, AU - Landewé,R, AU - van der Heijde,D, AU - Listing,J, AU - Brandt,J, AU - Braun,J, AU - Burgos-Vargas,R, AU - Collantes-Estevez,E, AU - Davis,J, AU - Dijkmans,B, AU - Dougados,M, AU - Emery,P, AU - van der Horst-Bruinsma,I E, AU - Inman,R, AU - Khan,M A, AU - Leirisalo-Repo,M, AU - van der Linden,S, AU - Maksymowych,W P, AU - Mielants,H, AU - Olivieri,I, AU - Sturrock,R, AU - de Vlam,K, AU - Sieper,J, Y1 - 2009/03/17/ PY - 2009/3/20/entrez PY - 2009/3/20/pubmed PY - 2009/6/25/medline SP - 770 EP - 6 JF - Annals of the rheumatic diseases JO - Ann. Rheum. Dis. VL - 68 IS - 6 N2 - OBJECTIVE: Non-radiographic axial spondyloarthritis (SpA) is characterised by a lack of definitive radiographic sacroiliitis and is considered an early stage of ankylosing spondylitis. The objective of this study was to develop candidate classification criteria for axial SpA that include patients with but also without radiographic sacroiliitis. METHODS: Seventy-one patients with possible axial SpA, most of whom were lacking definite radiographic sacroiliitis, were reviewed as "paper patients" by 20 experts from the Assessment of SpondyloArthritis international Society (ASAS). Unequivocally classifiable patients were identified based on the aggregate expert opinion in conjunction with the expert-reported level of certainty of their judgement. Draft criteria for axial SpA were formulated and tested using classifiable patients. RESULTS: Active sacroiliitis on magnetic resonance imaging (MRI) (odds ratio 45, 95% CI 5.3 to 383; p<0.001) was strongly associated with the classification of axial SpA. The knowledge of MRI findings led to a change in the classification of 21.1% of patients. According to the first set of candidate criteria (sensitivity 97.1%; specificity 94.7%) a patient with chronic back pain is classified as axial SpA in the presence of sacroiliitis by MRI or x rays in conjunction with one SpA feature or, if sacroilitiis is absent, in the presence of at least three SpA features. In a second set of candidate criteria, inflammatory back pain is obligatory in the clinical arm (sensitivity 86.1%; specificity 94.7%). CONCLUSION: The ASAS group has developed candidate criteria for the classification of axial SpA that include patients without radiographic sacroiliitis. The candidate criteria need to be validated in an independent international study. SN - 1468-2060 UR - https://www.unboundmedicine.com/medline/citation/19297345/The_development_of_Assessment_of_SpondyloArthritis_international_Society_classification_criteria_for_axial_spondyloarthritis__part_I_:_classification_of_paper_patients_by_expert_opinion_including_uncertainty_appraisal_ L2 - https://ard.bmj.com/cgi/pmidlookup?view=long&amp;pmid=19297345 DB - PRIME DP - Unbound Medicine ER -