Performance of clinical, laboratory and imaging features for diagnosing spondyloarthritis-a systematic literature review and meta-analysis.

Autor:	Bento da Silva A; Department of Rheumatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal.; Comprehensive Health Research Center, NOVA Medical School, Lisbon, Portugal.; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., Lourenço MH; Department of Rheumatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal.; Comprehensive Health Research Center, NOVA Medical School, Lisbon, Portugal.; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal., Ramiro S; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands., Falzon L; Health Economics and Decision Science, School of Medicine and Population Health, University of Sheffield, Sheffield, UK., Cunha-Branco J; Department of Rheumatology, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal.; Comprehensive Health Research Center, NOVA Medical School, Lisbon, Portugal., van der Heijde D; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., Landewé R; Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands.; Department of Rheumatology, Amsterdam University Medical Center, Amsterdam, The Netherlands., Sepriano A; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2024 Nov 01; Vol. 63 (11), pp. 2923-2937.
DOI:	10.1093/rheumatology/keae065
Abstrakt:	Objective: The Berlin algorithm was developed to help diagnose axial SpA (axSpA), but new studies suggest some features typical of SpA are less specific than previously assumed. Furthermore, evidence is lacking for other SpA subtypes (e.g. peripheral SpA). We aimed to review the evidence on the performance of SpA features for diagnosing each SpA subtype. Methods: We conducted a systematic literature review of studies reporting the diagnostic performance of one or more SpA features in patients with suspected SpA. The external reference was the rheumatologist's diagnosis of SpA. Meta-analysis was performed, separately for each SpA subtype, to estimate pooled sensitivity, specificity and positive and negative likelihood ratios (LR+ and LR-, respectively). Meta-regression assessed the effect of covariates (e.g. feature's prevalence) on each feature's performance. Results: Of 13 844 articles screened, 46 were included. Sacroiliitis on MRI, damage on pelvic radiographs and elevated CRP had the best balance between LR+ and LR- (LR+ 3.9-17.0, LR- 0.5-0.7) for diagnosing axSpA. HLA-B27 had an LR+ lower than anticipated (LR+ 3.1). Inflammatory back pain (IBP) had a low LR+ (LR+ ≈1), but substantially decreased the likelihood of axSpA when absent (LR- 0.3). Conversely, peripheral features and extramusculoskeletal manifestations showed a high LR+ (LR+ 1.6-5.0), but were as common in axSpA as non-axSpA (LR- ≈1). The specificity of most features was reduced in settings when these were highly prevalent. Limited data precluded a detailed analysis on diagnosing other SpA subtypes. Conclusion: Imaging features and CRP have good diagnostic value for axSpA. However, the specificity of other features, especially HLA-B27 and IBP, is lower than previously known. (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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