ASAS-CoMoSpA研究: 评价SpA不同分类标准的表现

ASAS-CoMoSpA研究: 评价SpA不同分类标准的表现

EULAR2015; PresentID: OP0037

THE PERFORMANCE OF DIFFERENT CLASSIFICATION CRITERIA SETS FOR SPONDYLOARTHRITIS IN THE ASAS-COMOSpA STUDY

P. Bakker^1,*, A. Moltó², A. Etcheto³, R. van den Berg¹, F. van Gaalen¹, F. van den Bosch⁴, R. Landewé⁵, M. Dougados², D. van der Heijde¹

¹LUMC, Leiden, Netherlands, ²René Descartes University, ³INSERM (U1153): Clinical Epidemiology and Biostatistics, Paris, France, ⁴Ghent University Hospital, Ghent, Belgium, ⁵AMC, Amsterdam, Netherlands

Background: Spondyloarthritis (SpA) includes patients with (predominantly) axial spondyloarthritis (axSpA) and patients with (predominantly) peripheral spondyloarthritis (pSpA) including psoriatic arthritis (PsA). Over time, several classification criteria sets have been developed to cover the whole spectrum of SpA.

Objectives: To compare the performance of different SpA classification criteria sets in the ASAS-COMOSpA study.

Methods: The ASAS-COMOSpA study is an international, cross-sectional study. Patients clinically diagnosed with SpA by the rheumatologist were included consecutively via routine care. For this analysis, patients were classified according to the ESSG, AMOR, mESSG (addition of MRI), mAMOR (addition of MRI), CASpAR and ASAS criteria for axSpA and pSpA.

Results: From 5 continents, 22 participating countries included 3984 patients: age 44 ± 14 years, 65% male gender, 56.2% HLA-B27+, psoriasis: 21.4%, uveitis: 19.6%, peripheral arthritis: 61.5%, mNY+ 64.4%, sacroiliitis on MRI (ASAS definition): 33.6%, negative rheumatoid factor (RF): 80.6%. Patients with up to 6 missing values were included (missing values set as absent); patients with ≥7 variables missing were left out of the analysis. Most common missing variables: MRI of the sacroiliac joints (ASAS definition; MRI-SI) (n=1951), juxta-articular bone formation (n=999), HLA-B27 (n=907), good response to NSAIDs (n=803), RF (n=613), radiographic sacroiliitis (n=341). Patients were classified according to the different classification criteria sets (table): data shown for all patients (left) and for patients with complete data regarding presence/absence of (radiographic/MRI) sacroiliitis and HLA-B27 (right). In addition, the overlap between the different classification criteria sets was assessed for patients with back pain and patients without back pain. The majority (of the patients) was classified by AMOR & ESSG & ASAS axSpA-criteria (n=1068). Most of the patients that were picked up by 1 criteria set only were classified by the ASAS axSpA-criteria (n=141; n=27 by AMOR and n=25 by ESSG). Similar trends were seen with regard to the mESSG and mAMOR-criteria. Regarding the patients with no back pain (peripheral complaints): again substantial overlap between the criteria was seen (ASAS pSpA, AMOR, ESSG, CASpAR. Patients fulfilling the imaging arm of the ASAS axSpA-criteria did not differ from patients fulfilling the clinical arm regarding the presence of most of the SpA-features. However, there were some notable differences: male gender (57.1% versus 62.8%), uveitis (13.3% versus 29.9%) and elevated CRP (52.0% versus 42.7%), imaging resp. clinical arm.

Conclusions: In this worldwide ASAS-COMOSpA study including established patients with SpA according to the rheumatologist, most patients fulfil several classification criteria sets; the biggest overlap between AMOR, ESSG and ASAS SpA. If patients fulfil only 1 criteria set this is most frequently the ASAS axSpA-criteria. Patients fulfilling the imaging arm or the clinical arm are comparable regarding most disease characteristics.

背景: SpA包括中轴SpA(axSpA)和外周SpA(pSpA), 后者包括银屑病关节炎(PsA)。随着时间推移, 已开发了多种分类标准以涵盖SpA整个疾病谱。

目标: 在ASAS-COMOSpA研究中评价SpA不同分类标准的表现。

方法: ASAS-COMOSpA研究是一项国际性的横断面研究。入组患者是由风湿病医师在常规诊疗中顺序收治并诊断为SpA的病人。本研究所要比较的分类标准包括ESSG、AMOR、mESSG(增加MRI条目)、mAMOR(增加MRI条目), CASpAR和ASAS标准(axSpA和pSpA)。

结果: 五大洲22个国家共纳入3984例患者, 年龄44±14岁, 65%男性, 56.2% HLA-B27阳性, 银屑病21.4%, 葡萄膜炎19.6%, 外周关节炎61.5%, 符合mNY标准64.4%, MRI骶髂关节炎(ASAS定义)阳性33.6%, RF阴性80.6%。缺失值≤6个的患者进入分析集(缺失值计做0), 有≥7个变量存在缺失值的患者不进入分析集。最常见缺失的变量: MRI骶髂关节(ASAS定义, MRI-SI, n=1951), 关节旁骨形成(n=999), HLA-B27(n=907), NSAIDs反应良好(n=803), RF(n=613), 放射学骶髂关节炎(n=341)。

根据不同的分类标准对患者进行分类(参见表), 表左侧是所有患者, 表右侧是所有能提供骶髂关节炎(放射学/MRI)和HLA-B27数据的患者。此外, 对有背痛和无背痛的患者分析不同分类标准的重叠情况。

大部分患者能够按照AMOR、ESSG和 ASAS-axSpA分类标准进行分类(n=1068, 参见图)。只能被某种分类标准所识别的患者中符合ASAS-axSpA标准的占了绝大多数(n=141；只符合AMOR或ESSG的分别有27例和25例)。换用mESSG和mAMOR标准也可见到这种趋势。在无背痛(但有外周关节受累)的患者中, 再次看到不同分类标准间的显著重叠(ASAS pSpA、AMOR、ESSG和CASpAR)。就SpA提示体征而言,符合ASAS-axSpA影像支分类标准的患者与符合临床支标准的患者之间无明显差别。然而, 影像支和临床支患者也有一些显著差异: 男性比例(57.1% vs 62.8%), 葡萄膜炎发生率(13.3% vs 29.9%), CRP升高(52.0% vs 42.7%)。

结论: 国际性ASAS-CoMoSpA研究纳入风湿病医生确诊的SpA患者, 大部分患者符合各种分类标准；AMOR、ESSG和ASAS-SpA分类标准具有最广泛的重叠。如果患者仅符合1种标准, ASAS-axSpA标准是适用性最广泛的。影像支和临床支患者大多数疾病特征都具有可比性。

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图. [译注: 拍摄自会议现场]