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Validation of the ASAS criteria and definition of a positive MRI of the sacroiliac joint in an inception cohort of axial spondyloarthritis followed up for 8 years.
Ann Rheum Dis 2012; 71(1):56-60AR

Abstract

BACKGROUND

The new Assessment of SpondyloArthritis international Society (ASAS) criteria classify axial spondyloarthritis (SpA) into human leucocyte antigen-B27 and/or imaging-based arms. To aid implementation, ASAS has proposed a definition of a positive MRI for active sacroiliitis.

OBJECTIVE

The authors aimed to test the diagnostic and predictive value of the ASAS criteria and definition of a 'positive' MRI.

METHODS

Baseline MRI scans on 29 patients with early inflammatory back pain and 18 controls were read independently by four experienced rheumatologists. Both arms of the criteria were tested against a 'gold standard' of physician diagnosis of SpA. MRI abnormalities were assessed according to a global assessment of MRI and the ASAS definition. Sensitivity, specificity and likelihood ratios for individual and concordant reader data were calculated for axial SpA diagnosis at baseline and the development of radiographic sacroiliitis, fulfilling the modified New York criteria at 8 years.

RESULTS

All patients were classified as having axial SpA, with more patients fulfilling the imaging arm (83%, n=24/29) than the human leucocyte antigen B27 arm (62%, n=18/29). Concordant reader data showed that the baseline MRI had high diagnostic utility for SpA according to global assessment (sensitivity/specificity: 66%/94%, LR+ (positive likelihood ratio) 11.8, LR- (negative likelihood ratio) 0.4) and ASAS definition (sensitivity/specificity: 79%/89%, LR+ 7.1, LR- 0.2). Likewise, a positive baseline MRI had 100% sensitivity for subsequent radiographic sacroiliitis by either assessment, although specificity was lower (56% for global assessment and 33% for ASAS definition).

CONCLUSION

Both arms of the ASAS criteria have good diagnostic utility in early SpA, although they are of limited value for the prediction of radiographic progression. This may be due to the definition of a positive MRI for sacroiliitis that lacks specificity at baseline.

Authors+Show Affiliations

Medeniyet University, Goztepe Training and Research Hospital. Rheumatology Unit, Istanbul, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

21900284

Citation

Aydin, Sibel Z., et al. "Validation of the ASAS Criteria and Definition of a Positive MRI of the Sacroiliac Joint in an Inception Cohort of Axial Spondyloarthritis Followed Up for 8 Years." Annals of the Rheumatic Diseases, vol. 71, no. 1, 2012, pp. 56-60.
Aydin SZ, Maksymowych WP, Bennett AN, et al. Validation of the ASAS criteria and definition of a positive MRI of the sacroiliac joint in an inception cohort of axial spondyloarthritis followed up for 8 years. Ann Rheum Dis. 2012;71(1):56-60.
Aydin, S. Z., Maksymowych, W. P., Bennett, A. N., McGonagle, D., Emery, P., & Marzo-Ortega, H. (2012). Validation of the ASAS criteria and definition of a positive MRI of the sacroiliac joint in an inception cohort of axial spondyloarthritis followed up for 8 years. Annals of the Rheumatic Diseases, 71(1), pp. 56-60. doi:10.1136/ard.2011.153064.
Aydin SZ, et al. Validation of the ASAS Criteria and Definition of a Positive MRI of the Sacroiliac Joint in an Inception Cohort of Axial Spondyloarthritis Followed Up for 8 Years. Ann Rheum Dis. 2012;71(1):56-60. PubMed PMID: 21900284.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validation of the ASAS criteria and definition of a positive MRI of the sacroiliac joint in an inception cohort of axial spondyloarthritis followed up for 8 years. AU - Aydin,Sibel Z, AU - Maksymowych,W P, AU - Bennett,A N, AU - McGonagle,D, AU - Emery,P, AU - Marzo-Ortega,H, Y1 - 2011/09/06/ PY - 2011/9/9/entrez PY - 2011/9/9/pubmed PY - 2012/2/9/medline SP - 56 EP - 60 JF - Annals of the rheumatic diseases JO - Ann. Rheum. Dis. VL - 71 IS - 1 N2 - BACKGROUND: The new Assessment of SpondyloArthritis international Society (ASAS) criteria classify axial spondyloarthritis (SpA) into human leucocyte antigen-B27 and/or imaging-based arms. To aid implementation, ASAS has proposed a definition of a positive MRI for active sacroiliitis. OBJECTIVE: The authors aimed to test the diagnostic and predictive value of the ASAS criteria and definition of a 'positive' MRI. METHODS: Baseline MRI scans on 29 patients with early inflammatory back pain and 18 controls were read independently by four experienced rheumatologists. Both arms of the criteria were tested against a 'gold standard' of physician diagnosis of SpA. MRI abnormalities were assessed according to a global assessment of MRI and the ASAS definition. Sensitivity, specificity and likelihood ratios for individual and concordant reader data were calculated for axial SpA diagnosis at baseline and the development of radiographic sacroiliitis, fulfilling the modified New York criteria at 8 years. RESULTS: All patients were classified as having axial SpA, with more patients fulfilling the imaging arm (83%, n=24/29) than the human leucocyte antigen B27 arm (62%, n=18/29). Concordant reader data showed that the baseline MRI had high diagnostic utility for SpA according to global assessment (sensitivity/specificity: 66%/94%, LR+ (positive likelihood ratio) 11.8, LR- (negative likelihood ratio) 0.4) and ASAS definition (sensitivity/specificity: 79%/89%, LR+ 7.1, LR- 0.2). Likewise, a positive baseline MRI had 100% sensitivity for subsequent radiographic sacroiliitis by either assessment, although specificity was lower (56% for global assessment and 33% for ASAS definition). CONCLUSION: Both arms of the ASAS criteria have good diagnostic utility in early SpA, although they are of limited value for the prediction of radiographic progression. This may be due to the definition of a positive MRI for sacroiliitis that lacks specificity at baseline. SN - 1468-2060 UR - https://www.unboundmedicine.com/medline/citation/21900284/Validation_of_the_ASAS_criteria_and_definition_of_a_positive_MRI_of_the_sacroiliac_joint_in_an_inception_cohort_of_axial_spondyloarthritis_followed_up_for_8_years_ L2 - https://ard.bmj.com/cgi/pmidlookup?view=long&pmid=21900284 DB - PRIME DP - Unbound Medicine ER -