Hospital Universitario de la Princesa, Servicio de Reumatología, C/Diego de León 62, Madrid 28006, Spain.
Rheumatology (Oxford). 2014 Feb;53(2):353-60. doi: 10.1093/rheumatology/ket359. Epub 2013 Nov 5.
The objective of this study was to analyse the performance of the Assessment of SpondyloArthritis International Society (ASAS) criteria for the classification of SpA in early SpA clinics.
We used a cross-sectional study of patients referred to early SpA units within the ESPERANZA programme (a Spanish nationwide health management programme designed to provide excellence in diagnosis and care for early SpA). Patients were eligible if they were <45 years of age and had any of the following: (i) a 2-year history of inflammatory back pain; (ii) back or joint pain with psoriasis, anterior uveitis, radiographic sacroiliitis, family history of SpA or positive HLA-B27; or (iii) asymmetric arthritis. We excluded patients for whom imaging (X-rays/MRI) or HLA-B27 results were not available. We analysed the performance (sensitivity and specificity) of different classification criteria sets, taking the rheumatologist's opinion as the gold standard.
The analysis included 775 patients [mean age 33 (s.d. 7) years; 55% men; mean duration of symptoms 11 (s.d. 6) months]; SpA was diagnosed in 538 patients (69.5%). A total of 274 (67.9%) patients with chronic back pain met the ASAS axial criteria, 76 (56.3%) patients with arthritis but not chronic back pain fulfilled the ASAS criteria for peripheral SpA and 350 (65.1%) fulfilled all the ASAS criteria. The sensitivity and specificity of the ASAS criteria set were 65% and 93%, respectively (axial criteria: sensitivity 68%, specificity 95%). The sensitivity and specificity for the ESSG and Amor criteria were 58% and 90% and 59% and 86%, respectively.
Despite performing better than the Amor or ESSG criteria, the ASAS criteria may be limited to detection of early forms, particularly in populations in which MRI is not extensively available or in populations with a low prevalence of HLA-B27.
本研究旨在分析评估脊柱关节炎国际协会（ASAS）分类标准在早期脊柱关节炎诊所中对脊柱关节炎（SpA）的分类性能。
我们使用了 ESPERANZA 计划中早期 SpA 单位的横断面研究（这是一个西班牙全国性的健康管理计划，旨在为早期 SpA 提供卓越的诊断和护理）。如果患者年龄<45 岁，且有以下任何一种情况，则符合入组条件：（i）2 年的炎性背痛病史；（ii）有背痛或关节痛，伴银屑病、前葡萄膜炎、放射学骶髂关节炎、SpA 家族史或 HLA-B27 阳性；或（iii）不对称关节炎。我们排除了影像学（X 线/MRI）或 HLA-B27 结果不可用的患者。我们分析了不同分类标准集的性能（敏感性和特异性），以风湿病医生的意见为金标准。
该分析共纳入 775 例患者[平均年龄 33（标准差 7）岁；55%为男性；症状平均持续时间 11（标准差 6）个月]；538 例（69.5%）患者被诊断为 SpA。共有 274 例（67.9%）慢性背痛患者符合 ASAS 轴性标准，76 例（56.3%）无慢性背痛但有关节炎的患者符合 ASAS 外周 SpA 标准，350 例（65.1%）符合所有 ASAS 标准。ASAS 标准集的敏感性和特异性分别为 65%和 93%（轴性标准：敏感性 68%，特异性 95%）。ESSG 和 Amor 标准的敏感性和特异性分别为 58%和 90%和 59%和 86%。
尽管 ASAS 标准的表现优于 Amor 或 ESSG 标准，但该标准可能仅限于检测早期形式，特别是在 MRI 广泛应用受限或 HLA-B27 流行率较低的人群中。
