Presence of multiple spondyloarthritis (SpA) features is important but not sufficient for a diagnosis of axial spondyloarthritis: data from the SPondyloArthritis Caught Early (SPACE) cohort.

Autor:	Ez-Zaitouni Z; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., Bakker PAC; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., van Lunteren M; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., Berg IJ; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway., Landewé R; Department of Clinical Immunology and Rheumatology, Amsterdam Medical Center, Amsterdam, The Netherlands., van Oosterhout M; Department of Rheumatology, Groene Hart Ziekenhuis, Gouda, The Netherlands., Lorenzin M; Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy., van der Heijde D; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., van Gaalen FA; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of the rheumatic diseases [Ann Rheum Dis] 2017 Jun; Vol. 76 (6), pp. 1086-1092. Date of Electronic Publication: 2017 Jan 06.
DOI:	10.1136/annrheumdis-2016-210119
Abstrakt:	Objectives: Concerns have been raised about overdiagnosis of axial spondyloarthritis (axSpA). We investigated whether patients with chronic back pain (CBP) of short duration and multiple SpA features are always diagnosed with axSpA by the rheumatologist, and to what extent fulfilment of the Assessment of SpondyloArthritis International Society (ASAS) axSpA criteria is associated with an axSpA diagnosis. Methods: Baseline data from 500 patients from the SPondyloArthritis Caught Early cohort which includes patients with CBP (≥3 months, ≤2 years, onset <45 years) were analysed. All patients underwent full diagnostic workup including MRI of the sacroiliac joints (MRI-SI) and radiograph of sacroiliac joints (X-SI). For each patient, the total number of SpA features excluding sacroiliac imaging and human leucocyte antigen B27 (HLA-B27) status was calculated. Results: Before sacroiliac imaging and HLA-B27 testing, 32% of patients had ≤1 SpA feature, 29% had 2 SpA features, 16% had 3 SpA features and 24% had ≥4 SpA features. A diagnosis of axSpA was made in 250 (50%) of the patients: 24% with ≤1 SpA feature, 43% with 2 SpA features, 62% with 3 SpA features and 85% with ≥4 SpA features. Of the 230 patients with a positive ASAS classification 40 (17.4%) did not have a diagnosis of axSpA. HLA-B27 positivity (OR 5.6; 95% CI 3.7 to 8.3) and any (MRI-SI and/or X-SI) positive imaging (OR 34.3; 95% CI 17.3 to 67.7) were strong determinants of an axSpA diagnosis. Conclusions: In this cohort of patients with CBP, neither the presence of numerous SpA features nor fulfilment of the ASAS classification criteria did automatically lead to a diagnosis axSpA. Positive imaging was considered particularly important in making a diagnosis of axSpA. Competing Interests: Competing interests: : None declared. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
Databáze:	MEDLINE
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