Elsevier

Joint Bone Spine

Volume 67, Issue 6, December 2000, Pages 516-520
Joint Bone Spine

ORIGINAL ARTICLE
Can some cases of ‘possible’ spondyloarthropathy be classified as ‘definite’ or ‘undifferentiated’ spondyloarthropathy?Value of criteria for spondyloarthropathies

https://doi.org/10.1016/S1297-319X(00)00201-3Get rights and content

Abstract

Objectives. When evaluating patients for spondyloarthropathy, clinicians use the ‘possible spondyloarthropathy’ category to indicate that they are unsure about the diagnosis. We sought to determine whether Amor’s criteria or the European Spondyloarthropathy Study Group (ESSG) criteria could lift this uncertainty. Patients and methods. During a Spanish study designed to validate criteria for spondyloarthropathies, 102 patients were classified in the ‘possible spondyloarthropathy’ category. We divided these patients into subgroups based on whether or not they met criteria for spondyloarthropathy. We compared baseline characteristics (N = 102) and five-year outcomes (N = 52) in these subgroups. Results. The following features were significantly more common in the subgroups of patients who met Amor’s criteria for spondyloarthropathy: oligoarthritis, heel pain, uveitis, balanitis, family history of spondyloarthropathy, and presence of the HLA B27 antigen. No differences were found for age at symptom onset, disease duration, buttock pain, gender, dactylitis, diarrhea, or psoriasis. Of the 52 patients followed up for five years, 17 met Amor’s criteria at baseline and 13 were subsequently found to have definite spondyloarthropathy, which was undifferentiated in six cases. There were only three cases of spondyloarthropathy among the 28 patients who did not meet Amor’s criteria at baseline. Of the 28 patients who met ESSG criteria at baseline, 13 had spondyloarthropathy versus three of the 17 patients who did not meet ESSG criteria at baseline. Conclusion. Amor’s criteria or the ESSG criteria allow early classification of most patients with ‘possible spondyloarthropathy’ and early identification of undifferentiated spondyloarthropathy corresponding to minimal-symptom or incipient disease. In this study, Amor’s criteria performed better than the ESSG criteria.

Section snippets

Initial study population

A multicenter study [15] was conducted by 28 rheumatology centers in 20 Spanish cities to validate Amor’s criteria and the ESSG criteria. The methodology was similar to that used earlier in a French validation study [13]. All the outpatients and inpatients seen during a one-week period were included. Rheumatologists used their personal experience (without reference to the criteria under study) to classify the patients into three groups, namely, definite spondyloarthropathy, possible

Characteristics at baseline

Table I reports the characteristics in the 102 patients with possible spondyloarthropathy. The most common symptoms were pain, morning stiffness of the lumbar spine, inflammatory back pain, and ill-defined buttock pain. A favorable response to nonsteroidal anti-inflammatory drug therapy was common.

Of the 102 patients, 49 did and 53 did not meet Amor’s criteria; corresponding figures for the ESSG criteria were 70 and 32. Table II shows the characteristics in these subgroups. No differences were

Discussion

In our outcome study, 13 of 52 patients had a spondyloarthropathy at completion of the five-year period. Seven patients were lost to follow-up, and 25 did not have a spondyloarthropathy. Amor’s criteria at baseline had a positive predictive value of 76% and a negative predictive value of 89% for spondyloarthropathy. Thus, use of these criteria at baseline would have ensured correct classification of most of the patients. The performance characteristics of the ESSG criteria in the same patients

Acknowledgements

We are grateful to the organizations that provided financial support to this study: the Fundación Hospital Reina Sofía-Cajasur, Junta de Andalucía (Consejería de Salud), and the Association cordouane contre la spondylarthrite ankylosante (ACEADE-LIRE). We thank Ms. Edith Wetcheler, and Mr. Nicolas Van Grunderbeeck (medical student, Erasmus program) for his technical assistance.

Members of the Spanish Spondyloarthropathy Study Group

M. Acasuso (La Coruña); E. Calero (Málaga); A. Collado

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