Clinical characteristics of non-radiographic versus radiographic axial spondyloarthritis in Asia and non-radiographic axial spondyloarthritis in other regions: results of the cross-sectional ASAS-COMOSPA study

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Abstract

Objectives

To delineate characteristics of non-radiographic axial spondyloarthritis (nr-axSpA) in Asia versus non-Asian regions, and compare radiographic axSpA (r-axSpA) with nr-axSpA within Asia.

Methods

Data were collected from the Assessment of SpondyloArthritis international Society-COMOrbidities in SPondyloArthritis database. Categorising patients by region, we compared clinical characteristics between nr-axSpA from Asia vs elsewhere (Europe, the Americas and Africa). Within Asians, we additionally compared patient characteristics of those with nr-axSpA versus r-axSpA.

Results

Among 3984 SpA cases, 1094 were from Asian countries. Of 780 axSpA patients in Asia, 112 (14.4%) had nr-axSpA, less than in non-Asian countries (486/1997, 24.3%). Nr-axSpA patients in Asia were predominantly male (75.9% vs 47.1%), younger at onset (22.8 vs 27.8 years) and diagnosis (27.2 vs 34.5 years), and experienced less diagnostic delay (1.9 vs 2.9 years) compared with nr-axSpA in non-Asian countries. Nr-axSpA in Asia exhibited higher human leucocyte antigens-B27 prevalence (90.6% vs 61.9%), fewer peripheral SpA features (53.6% vs 66.3%) and similar extra-articular and comorbid disease rates compared with those with nr-axSpA in non-Asian countries. Disease activity, functional impairment and MRI sacroiliitis were less in nr-axSpA in Asia, with higher rates of non-steroidal anti-inflammatory drug response and less methotrexate and biological disease-modifying antirheumatic drugs use. Within Asia, r-axSpA showed higher disease activity and structural damage compared with nr-axSpA, with no differences in other features.

Conclusion

Among axSpA, lower frequency of nr-axSpA was observed in Asia. Our results offer an opportunity to better understand clinical characteristics and optimise diagnostic strategies, such as ensuring access and availability of MRI resources for accurate diagnosis of nr-axSpA in Asia.

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Most cited references 38

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Investigation of the freely available easy-to-use software ‘EZR' for medical statistics

Y Kanda (2012)

Although there are many commercially available statistical software packages, only a few implement a competing risk analysis or a proportional hazards regression model with time-dependent covariates, which are necessary in studies on hematopoietic SCT. In addition, most packages are not clinician friendly, as they require that commands be written based on statistical languages. This report describes the statistical software ‘EZR' (Easy R), which is based on R and R commander. EZR enables the application of statistical functions that are frequently used in clinical studies, such as survival analyses, including competing risk analyses and the use of time-dependent covariates, receiver operating characteristics analyses, meta-analyses, sample size calculation and so on, by point-and-click access. EZR is freely available on our website (http://www.jichi.ac.jp/saitama-sct/SaitamaHP.files/statmed.html) and runs on both Windows (Microsoft Corporation, USA) and Mac OS X (Apple, USA). This report provides instructions for the installation and operation of EZR.

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The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection.

M Rudwaleit, D van der Heijde, R Landewé … (2009)

To validate and refine two sets of candidate criteria for the classification/diagnosis of axial spondyloarthritis (SpA). All Assessment of SpondyloArthritis international Society (ASAS) members were invited to include consecutively new patients with chronic (> or =3 months) back pain of unknown origin that began before 45 years of age. The candidate criteria were first tested in the entire cohort of 649 patients from 25 centres, and then refined in a random selection of 40% of cases and thereafter validated in the remaining 60%. Upon diagnostic work-up, axial SpA was diagnosed in 60.2% of the cohort. Of these, 70% did not fulfil modified New York criteria and, therefore, were classified as having "non-radiographic" axial SpA. Refinement of the candidate criteria resulted in new ASAS classification criteria that are defined as: the presence of sacroiliitis by radiography or by magnetic resonance imaging (MRI) plus at least one SpA feature ("imaging arm") or the presence of HLA-B27 plus at least two SpA features ("clinical arm"). The sensitivity and specificity of the entire set of the new criteria were 82.9% and 84.4%, and for the imaging arm alone 66.2% and 97.3%, respectively. The specificity of the new criteria was much better than that of the European Spondylarthropathy Study Group criteria modified for MRI (sensitivity 85.1%, specificity 65.1%) and slightly better than that of the modified Amor criteria (sensitivity 82.9, specificity 77.5%). The new ASAS classification criteria for axial SpA can reliably classify patients for clinical studies and may help rheumatologists in clinical practice in diagnosing axial SpA in those with chronic back pain. NCT00328068.

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Classification criteria for psoriatic arthritis: development of new criteria from a large international study.

William G. Taylor, Dafna D. Gladman, Philip Helliwell … (2006)

To compare the accuracy of existing classification criteria for the diagnosis of psoriatic arthritis (PsA) and to construct new criteria from observed data. Data were collected prospectively from consecutive clinic attendees with PsA and other inflammatory arthropathies. Subjects were classified by each of 7 criteria. Sensitivity and specificity were compared using conditional logistic regression analysis. Latent class analysis was used to calculate criteria accuracy in order to confirm the validity of clinical diagnosis as the gold standard definition of "case"-ness. Classification and Regression Trees methodology and logistic regression were used to identify items for new criteria, which were then constructed using a receiver operating characteristic curve. Data were collected on 588 cases and 536 controls with rheumatoid arthritis (n = 384), ankylosing spondylitis (n = 72), undifferentiated arthritis (n = 38), connective tissue disorders (n = 14), and other diseases (n = 28). The specificity of each set of criteria was high. The sensitivity of the Vasey and Espinoza method (0.97) was similar to that of the method of McGonagle et al (0.98) and greater than that of the methods of Bennett (0.44), Moll and Wright (0.91), the European Spondylarthropathy Study Group (0.74), and Gladman et al (0.91). The CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria consisted of established inflammatory articular disease with at least 3 points from the following features: current psoriasis (assigned a score of 2; all other features were assigned a score of 1), a history of psoriasis (unless current psoriasis was present), a family history of psoriasis (unless current psoriasis was present or there was a history of psoriasis), dactylitis, juxtaarticular new bone formation, rheumatoid factor negativity, and nail dystrophy. These criteria were more specific (0.987 versus 0.960) but less sensitive (0.914 versus 0.972) than those of Vasey and Espinoza. The CASPAR criteria are simple and highly specific but less sensitive than the Vasey and Espinoza criteria.

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Author and article information

Journal

Journal ID (nlm-ta): RMD Open

Journal ID (iso-abbrev): RMD Open

Journal ID (hwp): rmdopen

Journal ID (publisher-id): rmdopen

Title: RMD Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2056-5933

Publication date Collection: 2021

Publication date (Electronic): 16 September 2021

Volume: 7

Issue: 3

Electronic Location Identifier: e001752

Affiliations

[1 ]departmentDepartment of Nephrology and Rheumatology , Kyorin University School of Medicine , Mitaka, Tokyo, Japan

[2 ]departmentImmuno-Rheumatology Center , St Luke’s International University , Chuo-ku, Tokyo, Japan

[3 ]departmentCenter for Clinical Epidemiology , St Luke’s International University , Chuo-ku, Tokyo, Japan

[4 ]departmentDivision of Rheumatology, Inflammation, and Immunity , Brigham and Women’s Hospital , Boston, Massachusetts, USA

[5 ]departmentDepartment of Rheumatology , Tokyo Women’s Medical University , Shinjuku-ku, Tokyo, Japan

[6 ]departmentDivision of Rheumatology, Department of Internal Medicine , Keio University School of Medicine , Minato-ku, Tokyo, Japan

[7 ]departmentOrthopedics , Shiga University of Medical Science , Otsu, Japan

[8 ]departmentDepartment of Rheumatology , Teine Keijinkai Hospital , Sapporo, Hokkaido, Japan

[9 ]departmentDepartment of Orthopaedic Surgery , Fujita Health University , Toyoake, Aichi, Japan

[10 ]departmentDepartment of Internal Medicine and Rheumatology , Juntendo University Faculty of Medicine , Bunkyo-ku, Tokyo, Japan

[11 ]Chubu Rosai Hospital , Nagoya, Aichi, Japan

[12 ]departmentDepartment of Rheumatology , Fukujuji Hospital , Kiyose, Tokyo, Japan

[13 ]departmentDepartment of Endocrinology, Metabolism, Nephrology and Rheumatology , Kochi Medical School , Nankoku, Kochi, Japan

[14 ]Osaka Minami Medical Center , Kawachinagano, Osaka, Japan

[15 ]departmentDepartment of Internal Medicine and Rheumatology , Juntendo University Koshigaya Hospital , Koshigaya, Saitama, Japan

[16 ]departmentRheumatology Department , Hôpital Cochin - APHP Centre , Paris, France

[17 ]departmentRheumatology , Leiden University Medical Center , Leiden, Zuid-Holland, Netherlands

[18 ]departmentDepartment of Orthopaedic Biomaterial Science , Osaka University School of Medicine Graduate School of Medicine , Suita, Osaka, Japan

Author notes

[Correspondence to ] Dr Mitsumasa Kishimoto; kishimotomi@ 123456gmail.com

Author information

Mitsumasa Kishimoto http://orcid.org/0000-0002-4007-1589

Keisuke Ono http://orcid.org/0000-0002-2651-1509

Sho Fukui http://orcid.org/0000-0002-3082-1374

Satoshi Kawaai http://orcid.org/0000-0001-9457-036X

Yuko Kaneko http://orcid.org/0000-0003-2646-5765

Shigeto Kobayashi http://orcid.org/0000-0002-1939-3380

Yoshinori Komagata http://orcid.org/0000-0003-2047-4900

Clementina López-Medina http://orcid.org/0000-0002-2309-5837

Anna Molto http://orcid.org/0000-0003-2246-1986

Desirée van der Heijde http://orcid.org/0000-0002-5781-158X

Article

Publisher ID: rmdopen-2021-001752

DOI: 10.1136/rmdopen-2021-001752

PMC ID: 8449957

PubMed ID: 34531305

SO-VID: 1d1db80a-bb9d-4a44-bbd0-d206b0d878b3

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 26 May 2021

Date accepted : 28 August 2021

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Keywords: spondylitis,ankylosing,epidemiology,arthritis,psoriatic

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Keywords: spondylitis, ankylosing, epidemiology, arthritis, psoriatic

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Clinical characteristics of non-radiographic versus radiographic axial spondyloarthritis in Asia and non-radiographic axial spondyloarthritis in other regions: results of the cross-sectional ASAS-COMOSPA study

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Most cited references 38

Investigation of the freely available easy-to-use software ‘EZR' for medical statistics

The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection.

Classification criteria for psoriatic arthritis: development of new criteria from a large international study.

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