Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France.
Methodologie clinique, CIC, CHRU de Besançon, 25030 Besançon, France.
Joint Bone Spine. 2015 May;82(3):192-5. doi: 10.1016/j.jbspin.2014.12.008. Epub 2015 Jan 22.
There is no definition of flare in spondyloarthritis (SpA). The aim of this study was to evaluate thresholds of disease activity variations using validated composite indexes.
SpA patients (ASAS criteria) prospectively followed with at least two visits, were evaluated. Patients and physician answered at each visit the question: "do you consider your SpA/patient in a state of flare?". Variations of BASDAI and ASDAS between visits were assessed and associated to the change of perception of a flare (yes/no). ROC curves were built to assess thresholds of variation in BASDAI and ASDAS associated with the change flare between visits.
The patients were issued from a prospective series of 250 SpA. Ninety-nine cases with at least 2 visits were analysed. They were: 67% men, mean age 45±12 years; disease duration: 16±10 years; 84% HLA-B27 positive; purely axial SpA: 81%; PASS at baseline: 56%; mean CRP: 8.6±13.5mg/l. Mean BASDAI and ASDAS-CRP at baseline were 4.3±2.2 and 2.5±1.1, respectively. The kappa coefficient of agreement between patient and physician for considering a flare was 0.68. The main results of the ROC curves are: a variation ≥2.1 units in BASDAI (sensitivity 59%, specificity 83%), 0.8 units in ASDAS-ESR (sen 56%, spe 91%) or 1.3 units in ASDAS-CRP (sen 47%, spe 100%) is associated to a flare.
We propose thresholds of variations of BASDAI, ASDAS-ESR, and ASDAS-CRP associated to (and that may define) a flare, as considered by the patient and the physician.
脊柱关节炎（SpA）中尚无“ flare ”的定义。本研究旨在使用已验证的综合指标评估疾病活动变化的阈值。
前瞻性随访至少两次就诊的 SpA 患者。每次就诊时，患者和医生都会回答一个问题：“您是否认为您的 SpA/患者处于 flare 状态？”。评估两次就诊之间 BASDAI 和 ASDAS 的变化，并将其与对 flare 的感知变化（是/否）相关联。构建 ROC 曲线以评估 BASDAI 和 ASDAS 变化的阈值与就诊期间 flare 变化相关联。
这些患者来自一项前瞻性的 250 例 SpA 系列研究。分析了 99 例至少有 2 次就诊的病例。他们的特点为：男性占 67%，平均年龄 45±12 岁；病程：16±10 年；84% HLA-B27 阳性；单纯轴性 SpA：81%；基线时 PASS 为 56%；平均 CRP：8.6±13.5mg/l。基线时 BASDAI 和 ASDAS-CRP 的平均值分别为 4.3±2.2 和 2.5±1.1。患者和医生认为 flare 存在的一致性kappa 系数为 0.68。ROC 曲线的主要结果是：BASDAI 变化≥2.1 单位（敏感性 59%，特异性 83%）、ASDAS-ESR 变化 0.8 单位（敏感性 56%，特异性 91%）或 ASDAS-CRP 变化 1.3 单位（敏感性 47%，特异性 100%）与 flare 相关。
我们提出了与患者和医生认为的 flare 相关的（并可能定义为）BASDAI、ASDAS-ESR 和 ASDAS-CRP 变化的阈值。
