Axial spondyloarthritis classification criteria: the debate continues.
Axial spondyloarthritis classification criteria: the debate continues.
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DOI：
10.1097/bor.0000000000000402
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发表时间：
2017-07
影响因子：
5.1
通讯作者：
Deodhar AA
中科院分区：
文献类型：
--
作者：
Dubreuil M;Deodhar AA
国际脊柱关节炎评估协会（ASAS）中轴性脊柱关节炎（axSpA）分类标准标志着SpA研究向前迈出了重要一步，区分了轴性和外周性疾病，并允许通过MRI进行早期识别。这促进了研究的各个方面，包括流行病学，治疗学和患者结果。ASAS axSpA分类标准已广泛应用于研究，并在最近的国际研究荟萃分析中得到验证。由于临床和影像学组之间的临床差异引起了担忧，这意味着放射学进展的风险不同，并且在验证研究中表现不同。骶髂关节骨髓水肿MRI表现的低特异性可能导致axSpA患病率低的人群的错误分类。我们建议的方法，以改善的标准，包括严格评估潜在的候选标准集，离散选择实验，以考虑功能的权重，和验证。另外，应进行结构和炎症MRI异常的评估，以完善骶髂关节炎的MRI定义。关于ASAS axSpA分类标准的验证和修改的辩论应导致国际努力，以这些标准所取得的成果为基础，进一步完善研究的axSpA人群定义，并最终改善患者结局。
The Assessment of Spondyloarthritis International Society (ASAS) axial spondyloarthritis (axSpA) classification criteria marked a major step forward in SpA research, distinguishing axial from peripheral disease, and allowing earlier identification through MRI. This facilitated all aspects of research including epidemiology, therapeutics and patient outcomes. The ASAS axSpA classification criteria have been applied broadly in research, and were validated in a recent meta-analysis of international studies. Concerns arose due to clinical differences between the clinical and imaging arms, which imply different risk for radiographic progression, and perform differently in validation studies. Low specificity of the MRI finding of sacroiliac joint bone marrow edema may lead to misclassification in populations with low axSpA prevalence. We suggest methodology to improve upon the criteria, including rigorous assessment of potential candidate criteria sets, discrete choice experiments to allow consideration of feature weights, and validation. Separately, assessment of structural and inflammatory MRI abnormalities should be performed to refine the MRI definition of sacroiliitis. The debate regarding the validation and modification of the ASAS axSpA classification criteria should lead to international efforts to build upon the gains made by these criteria, to further refine the axSpA population definitions for research and ultimately improve patient outcomes.