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Extended report
Predictive validity of the ASAS classification criteria for axial and peripheral spondyloarthritis after follow-up in the ASAS cohort: a final analysis
  1. Alexandre Sepriano1,2,
  2. Robert Landewé3,4,
  3. Désirée van der Heijde1,
  4. Joachim Sieper5,6,
  5. Nurullah Akkoc7,
  6. Jan Brandt8,
  7. Jürgen Braun9,
  8. Eduardo Collantes-Estevez10,
  9. Maxime Dougados11,
  10. Oliver Fitzgerald12,
  11. Feng Huang13,
  12. Jieruo Gu14,
  13. Yesim Kirazli15,
  14. Walter P Maksymowych16,
  15. Helena Marzo-Ortega17,
  16. Ignazio Olivieri18,
  17. Salih Ozgocmen19,
  18. Euthalia Roussou20,
  19. Salvatore Scarpato21,
  20. Inge J Sørensen22,23,
  21. Rafael Valle-Oñate24,
  22. Filip Van den Bosch25,
  23. Irene van der Horst-Bruinsma26,
  24. Ulrich Weber27,28,
  25. James Wei29,
  26. Martin Rudwaleit30,31
  27. on behalf of ASAS
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Rheumatology, Hospital de Egas Moniz-CHLO, Lisbon, Portugal
  3. 3Departments of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Rheumatology, Atrium Medical Center, Heerlen, The Netherlands
  5. 5Department of Rheumatology, Med Klinik I, Charité Campus Benjamin Franklin, Berlin, Germany
  6. 6German Rheumatism Research Centre, Berlin, Germany
  7. 7Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
  8. 8Department of Rheumatology, Private Practice, Berlin, Germany
  9. 9Rheumazentrum Ruhrgebiet, Herne, Germany
  10. 10Rheumatology Department, “Reina Sofia” Hospital/IMIBIC/University of Córdoba, Córdoba, Spain
  11. 11Rheumatology Department, Paris Descartes University, Cochin Hospital, Paris, France
  12. 12Department of Rheumatology, St Vincent's University Hospital, Dublin, Elm Park, Ireland
  13. 13Department of Rheumatology, Chinese PLA General Hospital, Beijing, China
  14. 14Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  15. 15Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Izmir, Turkey
  16. 16Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  17. 17Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK
  18. 18Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
  19. 19Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Erciyes University, School of Medicine, Gevher Nesibe Hospital, Kayseri, Turkey
  20. 20Department of Rheumatology and Rehabilitation, King George's Hospital, London, UK
  21. 21Rheumatology Unit, M. Scarlato Hospital, Scafati, Salerno, Italy
  22. 22Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, Denmark
  23. 23Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  24. 24Division of Rheumatology, Department of Internal Medicine, Hospital Militar Central, Bogotá, Colombia
  25. 25Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
  26. 26Department of Rheumatology, VU University Medical Centre, Amsterdam, Netherlands
  27. 27King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and South Jutland Hospital, Denmark
  28. 28Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
  29. 29Chung Shan Medical University Hospital, Taichung, Taiwan
  30. 30Klinikum Bielefeld, Berlin, Germany
  31. 31Charité University Medicine, Berlin, Germany
  1. Correspondence to Dr Alexandre Sepriano, Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden 2300 RC, The Netherlands; alexsepriano{at}


Objective To establish the predictive validity of the Assessment of SpondyloArthritis international Society (ASAS) spondyloarthritis (SpA) classification criteria.

Methods 22 centres (N=909 patients) from the initial 29 ASAS centres (N=975) participated in the ASAS-cohort follow-up study. Patients had either chronic (>3 months) back pain of unknown origin and age of onset below 45 years (N=658) or peripheral arthritis and/or enthesitis and/or dactylitis (N=251). At follow-up, information was obtained at a clinic visit or by telephone. The positive predictive value (PPV) of the baseline classification by the ASAS criteria was calculated using rheumatologist's diagnosis at follow-up as external standard.

Results In total, 564 patients were assessed at follow-up (345 visits; 219 telephone) with a mean follow-up of 4.4 years (range: 1.9; 6.8) and 70.2% received a SpA diagnosis by the rheumatologist. 335 patients fulfilled the axial SpA (axSpA) or peripheral SpA (pSpA) criteria at baseline and of these, 309 were diagnosed SpA after follow-up (PPV SpA criteria: 92.2%). The PPV of the axSpA and pSpA criteria was 93.3% and 89.5%, respectively. The PPV for the ‘clinical arm only’ was 88.0% and for the ‘clinical arm’±‘imaging arm’ 96.0%, for the ‘imaging arm only’ 86.2% and for the ‘imaging arm’+/-‘clinical arm’ 94.7%. A series of sensitivity analyses yielded similar results (range: 85.1–98.2%).

Conclusions The PPV of the axSpA and pSpA criteria to forecast an expert's diagnosis of ‘SpA’ after more than 4 years is excellent. The ‘imaging arm’ and ‘clinical arm’ of the axSpA criteria have similar predictive validity and are truly complementary.

  • Spondyloarthritis
  • Outcomes research
  • Epidemiology

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