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
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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.
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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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    • "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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