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The performance of different classification criteria sets for spondyloarthritis in the worldwide ASAS-COMOSPA study

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Abstract
Background: In this study, we sought to compare the performance of spondyloarthritis (SpA) classification criteria sets in an international SpA cohort with patients included from five continents around the world. Methods: Data from the (ASAS) COMOrbidities in SPondyloArthritis (ASAS-COMOSPA) study were used. ASAS-COMOSPA is a multinational, cross-sectional study with consecutive patients diagnosed with SpA by rheumatologists worldwide. Patients were classified according to the European Spondyloarthropathy Study Group (ESSG), modified European Spondyloarthropathy Study Group (mESSG), Amor, modified Amor, Assessment of SpondyloArthritis international Society (ASAS) axial Spondyloarthritis (axSpA), ASAS peripheral spondyloarthritis (pSpA) and ClASsification criteria for Psoriatic Arthritis (CASPAR) criteria. Overlap between the classification criteria sets was assessed for patients with and without back pain. Furthermore, patients fulfilling different arms of the ASAS axSpA criteria (imaging arm, clinical arm, both arms) were compared on the presence of SpA features. Results: A total of 3942 patients (5 continents, 26 countries) were included. The mean age was 43.6 years, 65.0% were male, 56.2% were human leucocyte antigen B27-positive and 64.4% had radiographic sacroiliitis (based on modified New York criteria). Of the patients, 85.5% were classified by the ASAS SpA criteria (87.7% ASAS axSpA, 12.3% ASAS pSpA). Fulfilment of the Amor, ESSG and CASPAR criteria was present in 83.3%, 88.4% and 21.6% of patients, respectively. Of the patients with back pain (n = 3227), most were classified by all three of Amor, ESSG and ASAS axSpA criteria (71.4%). Patients fulfilling the imaging arm and the clinical arm of the ASAS axSpA criteria had similar presentations of SpA features. In patients without back pain, overlap between classification criteria sets was seen, although to a lesser extent. Conclusions: Most patients with a clinical diagnosis of axial SpA in the worldwide ASAS-COMOSPA study fulfil several classification criteria sets, and a substantial overlap between different criteria sets is seen, which suggests a high level of credibility of the criteria. Large inter-regional differences in the fulfilment of classification criteria were not found. Patients fulfilling the clinical arm were remarkably similar to patients fulfilling the imaging arm with respect to the presence of most SpA features.
Keywords
Spondyloarthritis, Classification criteria, Worldwide interregional differences, ANKYLOSING-SPONDYLITIS, PREVALENCE

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Chicago
Bakker, Pauline, Anna Moltó, Adrien Etcheto, Filip Van den Bosch, Robert Landewé, Floris van Gaalen, Maxime Dougados, and Désirée van der Heijde. 2017. “The Performance of Different Classification Criteria Sets for Spondyloarthritis in the Worldwide ASAS-COMOSPA Study.” Arthritis Research & Therapy 19 (1).
APA
Bakker, Pauline, Moltó, A., Etcheto, A., Van den Bosch, F., Landewé, R., van Gaalen, F., Dougados, M., et al. (2017). The performance of different classification criteria sets for spondyloarthritis in the worldwide ASAS-COMOSPA study. ARTHRITIS RESEARCH & THERAPY, 19(1).
Vancouver
1.
Bakker P, Moltó A, Etcheto A, Van den Bosch F, Landewé R, van Gaalen F, et al. The performance of different classification criteria sets for spondyloarthritis in the worldwide ASAS-COMOSPA study. ARTHRITIS RESEARCH & THERAPY. 2017;19(1).
MLA
Bakker, Pauline, Anna Moltó, Adrien Etcheto, et al. “The Performance of Different Classification Criteria Sets for Spondyloarthritis in the Worldwide ASAS-COMOSPA Study.” ARTHRITIS RESEARCH & THERAPY 19.1 (2017): n. pag. Print.
@article{8521995,
  abstract     = {Background: In this study, we sought to compare the performance of spondyloarthritis (SpA) classification criteria sets in an international SpA cohort with patients included from five continents around the world. 
Methods: Data from the (ASAS) COMOrbidities in SPondyloArthritis (ASAS-COMOSPA) study were used. ASAS-COMOSPA is a multinational, cross-sectional study with consecutive patients diagnosed with SpA by rheumatologists worldwide. Patients were classified according to the European Spondyloarthropathy Study Group (ESSG), modified European Spondyloarthropathy Study Group (mESSG), Amor, modified Amor, Assessment of SpondyloArthritis international Society (ASAS) axial Spondyloarthritis (axSpA), ASAS peripheral spondyloarthritis (pSpA) and ClASsification criteria for Psoriatic Arthritis (CASPAR) criteria. Overlap between the classification criteria sets was assessed for patients with and without back pain. Furthermore, patients fulfilling different arms of the ASAS axSpA criteria (imaging arm, clinical arm, both arms) were compared on the presence of SpA features. 
Results: A total of 3942 patients (5 continents, 26 countries) were included. The mean age was 43.6 years, 65.0\% were male, 56.2\% were human leucocyte antigen B27-positive and 64.4\% had radiographic sacroiliitis (based on modified New York criteria). Of the patients, 85.5\% were classified by the ASAS SpA criteria (87.7\% ASAS axSpA, 12.3\% ASAS pSpA). Fulfilment of the Amor, ESSG and CASPAR criteria was present in 83.3\%, 88.4\% and 21.6\% of patients, respectively. Of the patients with back pain (n = 3227), most were classified by all three of Amor, ESSG and ASAS axSpA criteria (71.4\%). Patients fulfilling the imaging arm and the clinical arm of the ASAS axSpA criteria had similar presentations of SpA features. In patients without back pain, overlap between classification criteria sets was seen, although to a lesser extent. 
Conclusions: Most patients with a clinical diagnosis of axial SpA in the worldwide ASAS-COMOSPA study fulfil several classification criteria sets, and a substantial overlap between different criteria sets is seen, which suggests a high level of credibility of the criteria. Large inter-regional differences in the fulfilment of classification criteria were not found. Patients fulfilling the clinical arm were remarkably similar to patients fulfilling the imaging arm with respect to the presence of most SpA features.},
  articleno    = {96},
  author       = {Bakker, Pauline and Molt{\'o}, Anna and Etcheto, Adrien and Van den Bosch, Filip and Landew{\'e}, Robert and van Gaalen, Floris and Dougados, Maxime and van der Heijde, D{\'e}sir{\'e}e},
  issn         = {1478-6362},
  journal      = {ARTHRITIS RESEARCH \& THERAPY},
  keyword      = {Spondyloarthritis,Classification criteria,Worldwide interregional differences,ANKYLOSING-SPONDYLITIS,PREVALENCE},
  language     = {eng},
  number       = {1},
  pages        = {8},
  title        = {The performance of different classification criteria sets for spondyloarthritis in the worldwide ASAS-COMOSPA study},
  url          = {http://dx.doi.org/10.1186/s13075-017-1281-5},
  volume       = {19},
  year         = {2017},
}

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