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Current Rheumatology Reports
Erschienen in: Current Rheumatology Reports 9/2015

01.09.2015 | Spondyloarthritis (MA Khan, Section Editor)

The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward

verfasst von: Sjef van der Linden, Nurullah Akkoc, Matthew A Brown, Philip C Robinson, Muhammad A Khan

Erschienen in: Current Rheumatology Reports | Ausgabe 9/2015

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Abstract

Classification criteria should facilitate selection of similar patients for clinical and epidemiologic studies, therapeutic trials, and research on etiopathogenesis to enable comparison of results across studies from different centers. We critically appraise the validity and performance of the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA). It is still debatable whether all patients fulfilling these criteria should be considered as having true axSpA. Patients with radiographically evident disease by the ASAS criteria are not necessarily identical with ankylosing spondylitis (AS) as classified by the modified New York criteria. The complex multi-arm selection design of the ASAS criteria induces considerable heterogeneity among patients so classified, and applying them in settings with a low prevalence of axial spondyloarthritis (SpA) greatly increases the proportion of subjects falsely classified as suffering from axial SpA. One of the unmet needs in non-radiographic form of axial SpA is to have reliable markers that can identify individuals at risk for progression to AS and thereby facilitate early intervention trials designed to prevent such progression. We suggest needed improvements of the ASAS criteria for axSpA, as all criteria sets should be regarded as dynamic concepts open to modifications or updates as our knowledge advances.
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Deodhar A, Reveille JD, van den Bosch F, Braun J, Burgos-Vargas R, Caplan L, et al. The concept of axial spondyloarthritis: joint statement of the spondyloarthritis research and treatment network and the Assessment of SpondyloArthritis international Society in response to the US Food and Drug Administration’s comments and concerns. Arthritis Rheum. 2014;66(10):2649–56. doi:10.​1002/​art.​38776. This special article summarises the discussions that took place at the meeting between SPARTAN and ASAS leadership, which was held to explore the consensus and also the differences regarding the concept of axial spondyloarthritis after the FDA’s rebuttal of approving TNF inhibitors for the treatment of nonradiographic axial spondyloarthritis. CrossRef
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58.••
Akkoc N, Khan MA. Looking into the New ASAS classification criteria for axial spondyloarthritis through the other side of the glass. Curr Rheumatol Rep. 2015;17(6):515. doi:10.​1007/​s11926-015-0515-2. This review addresses the several questions that have been raised regarding the new definition of nonradiographic axial spondyloarthritis as part of the axial spondyloarthritis. CrossRefPubMed
59.••
Robinson PC, Wordsworth BP, Reveille JD, Brown MA. Axial spondyloarthritis: a new disease entity, not necessarily early ankylosing spondylitis. Ann Rheum Dis. 2012;72(2):162--4. An excellent and concise editorial that details the evidence present at that time that axial SpA and ankylosing spondylitis differed in key demographic and genetic factors and that additional research was required to further elucidate the characteristics and natural history of axial SpA.
60.••
Taylor WJ, Robinson PC. Classification Criteria: peripheral spondyloarthropathy and psoriatic Arthritis. Current Rheumatology Reports. 2013;15(4). In this review article the authors have examined the construct of SpA and the basis for peripheral and axial SpA classification and point out the critical importance of accurate classification criteria to the study of SpA. Moreover, they have argued that this construct is less likely to advance knowledge in the study of psoriatic arthritis, and that the CASPAR criteria remain the best performing classification criteria for this disease.
61.••
Malaviya AN, Kalyani A, Rawat R, Gogia SB. Comparison of patients with ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA) from a single rheumatology clinic in New Delhi. Int J Rheum Dis. 2015. doi:10.​1111/​1756-185X.​12579. [Epub ahead of print]. This is another important publication that compared AS with nr-axSpA as classified by the ASAS classification criteria. The authors noted differences that show that these two clinical entities may not be the same disease, and they recommend performing a prospective long-term follow-up of large cohorts for clarifying if nr-axSpA is simply an early stage in the spectrum of SpA evolving into AS over time or is there inherent difference between them.
62.••
Aggarwal R, Ringold S, Khanna D, Neogi T, Johnson SR, Miller A, et al. Distinctions between diagnostic and classification criteria. Arthritis Care Res (Hoboken). 2015;67(7):891--7. doi:10.​1002/​acr.​22583. This is an excellent publication that clearly explains the differences between the diagnostic and the classification criteria.
Metadaten
Titel
The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward
verfasst von
Sjef van der Linden
Nurullah Akkoc
Matthew A Brown
Philip C Robinson
Muhammad A Khan
Publikationsdatum
01.09.2015
Verlag
Springer US
Erschienen in
Current Rheumatology Reports / Ausgabe 9/2015
Print ISSN: 1523-3774
Elektronische ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-015-0535-y

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