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Review
. 2017 Jul;29(4):317-322.
doi: 10.1097/BOR.0000000000000402.

Axial spondyloarthritis classification criteria: the debate continues

Maureen Dubreuil  1 , Atul A Deodhar
Affiliations
Review

Axial spondyloarthritis classification criteria: the debate continues

Maureen Dubreuil et al. Curr Opin Rheumatol. 2017 Jul.

Abstract

Purpose of review: The Assessment of Spondyloarthritis International Society (ASAS) axial spondyloarthritis (axSpA) classification criteria marked a major step forward in SpA research, distinguishing axial from peripheral disease, and allowing earlier identification through MRI. This facilitated all aspects of research including epidemiology, therapeutics and patient outcomes.

Recent findings: The ASAS axSpA classification criteria have been applied broadly in research, and were validated in a recent meta-analysis of international studies. Concerns arose because of clinical differences between the clinical and imaging arms, which imply different risk for radiographic progression, and perform differently in validation studies. Low specificity of the MRI finding of sacroiliac joint bone marrow edema may lead to misclassification in populations with low axSpA prevalence. We suggest methodology to improve upon the criteria, including rigorous assessment of potential candidate criteria sets, discrete choice experiments to allow consideration of feature weights, and validation. Separately, assessment of structural and inflammatory MRI abnormalities should be performed to refine the MRI definition of sacroiliitis.

Summary: The debate regarding the validation and modification of the ASAS axSpA classification criteria should lead to international efforts to build upon the gains made by these criteria, to further refine the axSpA population definitions for research and ultimately improve patient outcomes.

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Conflict of interest statement

Conflicts of interest: AD: Past-Chair, Spondyloarthritis Research & Treatment Network (SPARTAN); MD: None

Figures

Figure 1
Figure 1
ASAS classification criteria for axial spondyloarthritis *Sacroiliitis may be definite radiographically according to modified NY criteria, or by active inflammation on SI joint MRI (clear presence of bone marrow edema or osteitis). **Persons may satisfy the clinical arm if imaging results are unknown. References: [3, 4]
See this image and copyright information in PMC

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