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脊柱关节炎分类标准的效能:在众多拉丁美洲国家我们处于什么水平?一项系统文献综述和荟萃分析。

Performance of classification criteria for spondyloarthritis: where do we stand in many Latin American countries? A systematic literature review and meta-analysis.

作者信息

Calixto Omar-Javier, Meneses-Toro Maria-Alejandra, Garcia-Salinas Rodrigo, Bautista-Molano Wilson

机构信息

School of Medicine, Clinical Immunology Group, Universidad Militar Nueva Granada, Bogotá, Colombia.

Cellular and Molecular Immunology Group (InmuBo), Universidad El Bosque, Bogotá, Colombia.

出版信息

Clin Rheumatol. 2025 May 28. doi: 10.1007/s10067-025-07474-0.

Abstract

INTRODUCTION

Spondyloarthritis (SpA) encompasses a group of chronic inflammatory diseases affecting the spine and peripheral joints. Although classification criteria for SpA have been tested globally, their validity and performance in Latin American (LA) populations remain debated.

METHODS

A systematic literature review was conducted following PRISMA guidelines, with the protocol registered in PROSPERO (CRD42023464861). Searches were performed in Medline, Cochrane library, Embase and Virtual Health Library databases based on the PIRO framework. Studies assessing SpA classification criteria in LA patients were included, focusing on performance characteristics. Pooled sensitivity and specificity were estimated using a proportional meta-analysis with random-effect model, followed by sensitivity analysis.

RESULTS

Six studies met the inclusion criteria. Of the multinational studies, fewer than 10% included LA patients. Most of the studies evaluated the ASAS, the most recent criteria, and clinical diagnosis by a physician as the gold standard. The Amor criteria reported a pooled sensitivity of 71% and specificity of 46%. The ESSG criteria had a pooled sensitivity of 83% and specificity of 35%. The ASAS criteria had a pooled sensitivity of 75% and specificity of 43%.

CONCLUSIONS

These systematic literature review and meta-analysis, including SpA patients from six LA countries, suggest that the ASAS classification criteria offer the best balance for sensitivity and specificity. However, these findings highlight the need for high-quality, homogeneous studies to validate SpA classification criteria in LA populations as patient assessment continues to evolve.

摘要

引言

脊柱关节炎(SpA)是一组影响脊柱和外周关节的慢性炎症性疾病。尽管SpA的分类标准已在全球范围内进行了测试,但其在拉丁美洲(LA)人群中的有效性和性能仍存在争议。

方法

按照PRISMA指南进行系统的文献综述,方案已在PROSPERO(CRD42023464861)中注册。基于PIRO框架在Medline、Cochrane图书馆、Embase和虚拟健康图书馆数据库中进行检索。纳入评估LA患者SpA分类标准的研究,重点关注性能特征。使用随机效应模型的比例荟萃分析估计合并敏感性和特异性,随后进行敏感性分析。

结果

六项研究符合纳入标准。在跨国研究中,纳入的LA患者不到10%。大多数研究评估了最新的标准——ASAS,以及以医生的临床诊断作为金标准。Amor标准的合并敏感性为71%,特异性为46%。ESSG标准的合并敏感性为83%,特异性为35%。ASAS标准的合并敏感性为75%,特异性为43%。

结论

这项包括来自六个LA国家的SpA患者的系统文献综述和荟萃分析表明,ASAS分类标准在敏感性和特异性方面提供了最佳平衡。然而,这些发现凸显了随着患者评估的不断发展,需要高质量、同质的研究来验证LA人群中SpA分类标准的必要性。

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