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Current Rheumatology Reports
Published in: Current Rheumatology Reports 9/2015

01-09-2015 | Spondyloarthritis (MA Khan, Section Editor)

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

Authors: Sjef van der Linden, Nurullah Akkoc, Matthew A Brown, Philip C Robinson, Muhammad A Khan

Published in: Current Rheumatology Reports | Issue 9/2015

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Abstract

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.
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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.​1111/​1756-185X.​12579. [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.
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Metadata
Title
The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward
Authors
Sjef van der Linden
Nurullah Akkoc
Matthew A Brown
Philip C Robinson
Muhammad A Khan
Publication date
01-09-2015
Publisher
Springer US
Published in
Current Rheumatology Reports / Issue 9/2015
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-015-0535-y

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