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Predictive validity of the ASAS classification criteria for axial and peripheral spondyloarthritis after follow-up in the ASAS cohort: a final analysis

2016; BMJ; Volume: 75; Issue: 6 Linguagem: Inglês

10.1136/annrheumdis-2015-208730

1468-2060

Alexandre Sepriano, Robert Landewé, Désirée van der Heijde, Joachim Sieper, Nurullah Akkoç, J. Brandt, J. Braun, Eduardo Collantes‐Estévez, Maxime Dougados, Oliver FitzGerald, Feng Huang, Jieruo Gu, Yeşim Kirazlı, Walter P. Maksymowych, Helena Marzo‐Ortega, Ignazio Olivieri, Salih Özgöçmen, Euthalia Roussou, Salvatore Scarpato, Inge Juul Sørensen, Rafael Valle‐Oñate, Filip Van den Bosch, Irene van der Horst‐Bruinsma, Ulrich Weber, James Cheng‐Chung Wei, Martín Rudwaleit,

Rheumatoid Arthritis Research and Therapies

Objective To establish the predictive validity of the Assessment of SpondyloArthritis international Society (ASAS) spondyloarthritis (SpA) classification criteria. Methods 22 centres (N=909 patients) from the initial 29 ASAS centres (N=975) participated in the ASAS-cohort follow-up study. Patients had either chronic (>3 months) back pain of unknown origin and age of onset below 45 years (N=658) or peripheral arthritis and/or enthesitis and/or dactylitis (N=251). At follow-up, information was obtained at a clinic visit or by telephone. The positive predictive value (PPV) of the baseline classification by the ASAS criteria was calculated using rheumatologist's diagnosis at follow-up as external standard. Results In total, 564 patients were assessed at follow-up (345 visits; 219 telephone) with a mean follow-up of 4.4 years (range: 1.9; 6.8) and 70.2% received a SpA diagnosis by the rheumatologist. 335 patients fulfilled the axial SpA (axSpA) or peripheral SpA (pSpA) criteria at baseline and of these, 309 were diagnosed SpA after follow-up (PPV SpA criteria: 92.2%). The PPV of the axSpA and pSpA criteria was 93.3% and 89.5%, respectively. The PPV for the ‘clinical arm only’ was 88.0% and for the ‘clinical arm’±‘imaging arm’ 96.0%, for the ‘imaging arm only’ 86.2% and for the ‘imaging arm’+/-‘clinical arm’ 94.7%. A series of sensitivity analyses yielded similar results (range: 85.1–98.2%). Conclusions The PPV of the axSpA and pSpA criteria to forecast an expert's diagnosis of ‘SpA’ after more than 4 years is excellent. The ‘imaging arm’ and ‘clinical arm’ of the axSpA criteria have similar predictive validity and are truly complementary.