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

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• 作者：Sjef van der Linden ; Nurullah Akkoc ; Matthew A Brown&#8230
• 关键词：Assessment of SpondyloArthritis international Society (ASAS) ; ASAS classification criteria ; Spondyloarthritis (SpA) ; Axial spondyloarthritis (axSpA) ; Ankylosing spondylitis (AS)
• 刊名：Current Rheumatology Reports
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：17
• 期：9
• 全文大小：1,023 KB
• 参考文献：Papers of particular interest, published recently, have been highlighted as: 鈥?Of importance 鈥⑩€?Of major importance1.Rudwaleit M, Landewe R, van der Heijde D, Listing J, Brandt J, Braun J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009;68(6):770鈥?. doi:10.鈥?136/鈥媋rd.鈥?009.鈥?08217 .View Article PubMed
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  21.鈥?/div>Sieper J, van der Heijde D, Dougados M, Mease PJ, Maksymowych WP, Brown MA, et al. Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1). Ann Rheum Dis. 2013;72(6):815鈥?2. doi:10.鈥?136/鈥媋nnrheumdis-2012-201766 . The first clinical trial that utilized the ASAS axial spondyloarthritis criteria that showed that treatment with adalimumab has a positive benefit鈥搑isk profile in patients with active nonradiographic axial spondyloarthritis patients that had shown inadequate response to NSAIDs. PubMed Central View Article PubMed
  22.鈥?/div>Landewe R, Braun J, Deodhar A, Dougados M, Maksymowych WP, Mease PJ, et al. Efficacy of certolizumab pegol on signs and symptoms of axial spondyloarthritis including ankylosing spondylitis: 24-week results of a double-blind randomised placebo-controlled phase 3 study. Ann Rheum Dis. 2014;73(1):39鈥?7. doi:10.鈥?136/鈥媋nnrheumdis-2013-204231 . This is the first trial of a TNF inhibitor that included patients with ankylosing spondylitis and non-radiographic axial in spondyloarthritis in one single study, which reported that certolizumab is effective in treating the signs and symptoms of axial SpA. PubMed Central View Article PubMed
  23.鈥?/div>Dougados M, van der Heijde D, Sieper J, Braun J, Maksymowych WP, Citera G, et al. Symptomatic efficacy of etanercept and its effects on objective signs of inflammation in early nonradiographic axial spondyloarthritis: a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2014;66(8):2091鈥?02. doi:10.鈥?002/鈥媋rt.鈥?8721 . In this randomized controlled trial, etanercept showed good efficacy in patients with nonradiographic axial spondyloarthritis over 12聽weeks with clinical/functional improvement continuing through 24聽weeks. View Article
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  55.鈥⑩€?/div>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鈥檚 comments and concerns. Arthritis Rheum. 2014;66(10):2649鈥?6. doi:10.鈥?002/鈥媋rt.鈥?8776 . 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鈥檚 rebuttal of approving TNF inhibitors for the treatment of nonradiographic axial spondyloarthritis. View Article
  56.鈥⑩€?/div>van Tubergen A. The changing clinical picture and epidemiology of spondyloarthritis. Nat Rev Rheumatol. 2015;11(2):110鈥?. doi:10.鈥?038/鈥媙rrheum.鈥?014.鈥?81 . This is a good review on the change in our understanding of the clinical aspects and epidemiology of spondylitis, but the author made one common mistake when she stated that radiographic axial spondyloarthritis is identical to ankylosing spondylitis. View Article PubMed
  57.Braun J, Baraliakos X, Kiltz U, Heldmann F, Sieper J. Classification and diagnosis of axial spondyloarthritis鈥攚hat is the clinically relevant difference? J Rheumatol. 2015;42(1):31鈥?. doi:10.鈥?899/鈥媕rheum.鈥?30959 .View Article PubMed
  58.鈥⑩€?/div>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.鈥?007/鈥媠11926-015-0515-2 . This review addresses the several questions that have been raised regarding the new definition of nonradiographic axial spondyloarthritis as part of the axial spondyloarthritis. View Article PubMed
  59.鈥⑩€?/div>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.鈥⑩€?/div>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.鈥⑩€?/div>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.鈥?111/鈥?756-185X.鈥?2579 . [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.鈥⑩€?/div>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.鈥?002/鈥媋cr.鈥?2583 . This is an excellent publication that clearly explains the differences between the diagnostic and the classification criteria.
  
• 作者单位：Sjef van der Linden (1)
  Nurullah Akkoc (2)
  Matthew A Brown (3)
  Philip C Robinson (4) (5)
  Muhammad A Khan (6)
  
  1. Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, P.O. Box 5800, NL-6202-AZ, Maastricht, The Netherlands
  2. Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, Balcova, 35340, Izmir, Turkey
  3. University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Level 7, Kent Street, Woolloongabba, QLD, 4102, Australia
  4. Centre for Neurogenetics and Statistical Genomics, Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
  5. Royal Brisbane and Women and Statistical Genomics, Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
  6. MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA
  
• 刊物主题：Rheumatology;
• 出版者：Springer US
• ISSN：1534-6307

文摘

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.