The Development of Assessment of SpondyloArthritis international Society (ASAS) Classification Criteria for Axial Spondyloarthritis (Part II): validation and final selection

Med Klinik I, Charité, Campus Benjamin Franklin, Berlin, Germany.
Annals of the rheumatic diseases (Impact Factor: 10.38). 03/2009; 68(6):777-83. DOI: 10.1136/ard.2009.108233
Source: PubMed


To validate and refine two sets of candidate criteria for the classification/diagnosis of axial spondyloarthritis (SpA).
All Assessment of SpondyloArthritis international Society (ASAS) members were invited to include consecutively new patients with chronic (> or =3 months) back pain of unknown origin that began before 45 years of age. The candidate criteria were first tested in the entire cohort of 649 patients from 25 centres, and then refined in a random selection of 40% of cases and thereafter validated in the remaining 60%.
Upon diagnostic work-up, axial SpA was diagnosed in 60.2% of the cohort. Of these, 70% did not fulfil modified New York criteria and, therefore, were classified as having "non-radiographic" axial SpA. Refinement of the candidate criteria resulted in new ASAS classification criteria that are defined as: the presence of sacroiliitis by radiography or by magnetic resonance imaging (MRI) plus at least one SpA feature ("imaging arm") or the presence of HLA-B27 plus at least two SpA features ("clinical arm"). The sensitivity and specificity of the entire set of the new criteria were 82.9% and 84.4%, and for the imaging arm alone 66.2% and 97.3%, respectively. The specificity of the new criteria was much better than that of the European Spondylarthropathy Study Group criteria modified for MRI (sensitivity 85.1%, specificity 65.1%) and slightly better than that of the modified Amor criteria (sensitivity 82.9, specificity 77.5%).
The new ASAS classification criteria for axial SpA can reliably classify patients for clinical studies and may help rheumatologists in clinical practice in diagnosing axial SpA in those with chronic back pain. Trial registration number: NCT00328068.

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Available from: Eduardo Collantes-Estevez, Oct 09, 2015
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    • "Ankylosing spondylitis (AS) is the prototype of Spondyloarthritis (SpA) [1], [2], a group of diseases sharing clinical, radiographic and genetic features [1], [2]. Despite intensive research, the pathogenesis of SpA is not well understood, and evidence suggesting the implication of either autoinflammatory or autoimmune mechanisms has been reported [3]. "
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    ABSTRACT: Follicular helper T cells (Tfh), localized in lymphoid organs, promote B cell differentiation and function. Circulating CD4 T cells expressing CXCR5, ICOS and/or PD-1 are counterparts of Tfh. Three subpopulations of circulating CD4+CXCR5+ cells have been described: CXCR3+CCR6- (Tfh-Th1), CXCR3-CCR6+ (Tfh-Th17), and CXCR3-CCR6- (Tfh-Th2). Only Tfh-Th17 and Tfh-Th2 function as B cell helpers. Our objective was to study the frequencies of circulating Tfh (cTfh), cTfh subsets and plasmablasts (CD19+CD20-CD27+CD38high cells), and the function of cTfh cells, in patients with Ankylosing Spondylitis (AS). To this end, peripheral blood was drawn from healthy controls (HC) (n = 50), AS patients naïve for TNF blockers (AS/nb) (n = 25) and AS patients treated with TNF blockers (AS/b) (n = 25). The frequencies of cTfh and plasmablasts were determined by flow cytometry. Cocultures of magnetically sorted CD4+CXCR5+ T cells with autologous CD19+CD27- naïve B cells were established from 3 AS/nb patients and 3 HC, and concentrations of IgG, A and M were measured in supernatants. We obseved that AS/nb but not AS/b patients, demonstrated decreased frequencies of circulating CD4+CXCR5+ICOS+PD-1+ cells and plasmablasts, together with a decreased (Tfh-Th17+Tfh-Th2)/Tfh-Th1 ratio. The amounts of IgG and IgA produced in cocultures of CD4+CXCR5+ T cells with CD19+CD27- B cells of AS/nb patients were significantly lower than observed in cocultures established from HC. In summary, AS/nb but not AS/b patients, demonstrate a decreased frequency of cTfh and plasmablasts, and an underrepresentation of cTfh subsets bearing a B helper phenotype. In addition, peripheral blood CD4+CXCR5+ T cells of AS/nb patients showed a decreased capacity to help B cells ex vivo.
    PLoS ONE 09/2014; 9(9):e107086. DOI:10.1371/journal.pone.0107086 · 3.23 Impact Factor
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    • "In RA patients in the SSAGT (29) and DANBIO studies (14), the main causes of TNF inhibitor withdrawal were adverse events and lack of efficacy. In AS patients in the same studies (20, 29), the reasons for treatment withdrawal were almost equally distributed among adverse events, inefficacy, and other reasons including disease remission and follow-up loss. In our study, more than half of RA patients discontinued the drugs due to inefficacy; another main reason was the occurrence of adverse events. "
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    ABSTRACT: We investigated the compliance of Korean patients using tumor necrosis factor (TNF) inhibitors to treat rheumatoid arthritis (RA) and ankylosing spondylitis (AS), and identified potential predictors associated with treatment discontinuation. The study population comprised 114 RA and 310 AS patients treated with TNF inhibitors at a single tertiary center for at least 1 yr from December 2002 to November 2011. Of the 114 RA patients, 64 (56.1%) discontinued their first TNF inhibitors with a mean duration of 18.1 months. By contrast, 65 of 310 patients (21.0%) with AS discontinued their first TNF inhibitors, with a mean duration of 84 months. Although the survival rate did not differ among the three TNF inhibitors in the AS patients, the etanercept group had a lower discontinuation rate than the infliximab group in the RA patients. In addition, RA patients who received corticosteroids in combination with TNF inhibitors were more likely to discontinue their TNF inhibitors. The independent predictors of drug discontinuation in AS patients were male gender and complete ankylosis on radiographs of the sacroiliac joint. Our results provide further evidence that real-life treatment outcomes of RA and AS patients may be different from those observed in randomized clinical trials. Graphical Abstract
    Journal of Korean Medical Science 09/2014; 29(9):1205-11. DOI:10.3346/jkms.2014.29.9.1205 · 1.27 Impact Factor
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    • "Malgré les différentes conférences de consensus, l'utilisation variée de ces différents termes a persisté [11]. La publication des critères de classification de l'Assessment of SpondyloArthritis International Society (ASAS) des spondyloarthrites axiales et des spondyloarthrites périphériques n'a finalement retenu que le terme générique anglais de spondyloarthritis [2] [3] [4]. Il a été récemment proposé de traduire ce terme en franç ais par « spondyloarthrite », terme qui a l'avantage de faire ressortir le caractère inflammatoire des spondyloarthrites, tout en évitant la confusion restrictive qui existait avec le terme « spondylarthrite », très lié à la SA [10] "
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    ABSTRACT: Spondyloarthritis are undoubtedly the nosological group in Rheumatology whose evolution in terminology has more varied. Over the decades, many systems of criteria were published, mainly classification criteria, with the purpose to “classify” the maximum of patients. This scalability has been favored by the heterogeneous nature of the unified concept of spondyloarthritis, punctuated by a better understanding over the years of clinical, genetic predisposition associated, and the pathogenesis of various entities included in this concept. Thus the Rome criteria, the New York criteria, and the modified New York criteria were successively published for ankylosing spondylitis. After them, the Amor and ESSG criteria for spondyloarthropathy were published. The evolution of the concept of spondyloarthritis leads us to use currently the ASAS criteria for axial and peripheral spondyloarthritis, according to the predominant symptoms, axial or peripheral. An important step was also crossed with the use of MRI in these criteria. The strengths and limitations of these criteria are presented in this paper. These criteria are in turn expected to evolve over time. The ultimate goal will be to make the future ASAS criteria, a diagnostic and classification criteria, allowing both the detection unequivocally of recent forms, with recognizing the old and polymorphs forms. However, to avoid the overdiagnosis in non-radiographic forms, vigilance and a rigorous semiological analysis are required.
    Revue du Rhumatisme Monographies 07/2014; 81(4). DOI:10.1016/j.monrhu.2014.06.003
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