Background In 2010, the Assessments in Ankylosing Spondylitis Society (ASAS) and the European League Against Rheumatism (EULAR) updated management recommendations for ankylosing spondylitis. Applicable to all patients with axial spondyloarthritis (SpA), recommendations are in the form of general treatment principles and contain no specific, quantitative elements of care, i.e., quality criteria. This precludes the identification of axial SpA patients receiving or nor receiving recommended care, hindering the evaluation of clinical and economic benefits of applying SpA management recommendations.
Objectives To establish by expert consensus a quantitative definition of items in the ASAS/EULAR axial SpA recommendations, i.e., quality criteria.
Methods A two-step process was implemented. First, a working group of 4 rheumatologist members of EULAR, ASAS and the scientific committee of the DESIR SpA cohort developed preliminary, quantitative definitions of each recommendation. These definitions were presented in a Delphi questionnaire, which was completed in iterations by 15 rheumatologists representing membership in ASAS, EULAR, and DESIR. Following the first iteration (Round 1), the percent agreement with each definition was presented, along with alternative definitions or amendments to wording proposed by participants. Questions which in Round 1 drew 75% or greater consensus for a single definition and no proposed amendments did not appear in Round 2; definitions with 25% or less consensus in Round 1 also did not appear in Round 2. The same rules were applied in Round 3. In addition, in Round 3, amendments to wording proposed by participants (which appeared only in Round Two) were removed if consensus was under 50% and accepted if consensus was over 75%. Only amendments with consensus in between 50-74% re-appeared in Round 3.
Results Among 11 items in the ASAS recommendations, 4 were found by the working group to be non-quantifiable, i.e., no quality criteria proposed. These items drew high levels of consensus in Round 1 (%) to be deemed non-quantifiable, “General Treatment” (100%), “Disease Monitoring” (91.7%), “Analgesics” (100%), “Changes in disease course” (100%), as did the item “Surgery” (91.67%) (one definition proposed). Based on Round 1 results, Round 2 presented two competing definitions for “Non-Pharmacological Therapy”; four possible amendments to “Extra-Articular Manifestations and Co-Morbidities”; three competing definitions and two possible amendments to 'Non-Steroidal Anti-Inflammatory Drugs'; three possible amendments to 'Disease-Modifying Anti-Rheumatic drugs'; three possible amendments to “Anti-TNF Agents”. Final definitions for the 6 quantifiable items are presented in Table 1.
Conclusions The study enabled the constitution of a candidate set of AS-care quality criteria based on the ASAS/EULAR recommendations. These criteria will help the assessment of clinical - and economic - benefits of applying SpA management recommendations.
Disclosure of Interest None declared