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Scientific Abstracts
Oral Presentations
Clinical aspects and Treatment of axSpA: effects and predictors of effects
OP0055 ASAS CONSENSUS DEFINITION OF EARLY AXIAL SPONDYLOARTHRITIS
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  1. V. Navarro-Compán1,
  2. D. Benavent1,
  3. D. Capelusnik2,3,
  4. D. Van der Heijde4,
  5. R. B. M. Landewé5,
  6. D. Poddubnyy6,
  7. A. Van Tubergen2,7,
  8. X. Baraliakos8,
  9. F. Van den Bosch9,
  10. F. A. Van Gaalen4,
  11. L. S. Gensler10,
  12. C. López-Medina11,
  13. H. Marzo-Ortega12,
  14. A. Moltó13,
  15. R. Perez Alamino14,
  16. M. Rudwaleit15,
  17. M. G. H. Van de Sande16,
  18. R. Sengupta17,
  19. U. Weber18,
  20. S. Ramiro4
  1. 1La Paz University Hospital, IdiPaz, Rheumatology, Madrid, Spain
  2. 2Care and Public Health Research Institute (CAPHRI), Rheumatology, Maastricht, Netherlands
  3. 3Tel Aviv Sourasky Medical Center, Rheumatology, Tel Aviv, Israel
  4. 4Leiden University Medical Center, Rheumatology, Leiden, Netherlands
  5. 5Amsterdam University Medical Center, University of Amsterdam, Rheumatology & Clinical Immunology, Amsterdam, Netherlands
  6. 6Charité - Universitätsmedizin Berlin and German Rheumatism Research Centre, Rheumatology, Berlin, Netherlands
  7. 7Maastricht University Medical Center, Rheumatology, Maastricht, Netherlands
  8. 8Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Rheumatology, Bochum, Herne, Netherlands
  9. 9VIB Center for Inflammation Research and Department of Internal Medicine and Pediatrics, Ghent University, Rheumatology, Ghent, Belgium
  10. 10Division of Rheumatology, University of California, Department of Medicine, San Francisco, California, United States of America
  11. 11Reina Sofia University Hospital, IMIBIC, University of Cordoba, Rheumatology, Córdoba, Spain
  12. 12NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Rheumatology, Leeds, United Kingdom
  13. 13Cochin Hospital, APHP, Rheumatology, Paris, France
  14. 14Hospital Avellaneda, Rheumatology, Tucumán, Argentina
  15. 15Klinikum Bielefeld, University of Bielefeld, Internal Medicine and Rheumatology, Bilefeld, Germany
  16. 16Amsterdam University Medical Center, Rheumatology & Clinical Immunology, Amsterdam, Netherlands
  17. 17Royal National Hospital for Rheumatic Diseases, Rheumatology, Bath, United Kingdom
  18. 18Practice Buchsbaum, Rheumatology, Rheumatology, Schaffhausen, Switzerland

Abstract

Background There is a growing interest in understanding the early disease stages of axial and peripheral SpA (axSpA and pSpA). In order to facilitate this, standardized definitions are needed for research purposes.

Objectives To develop a consensual definition for the terms “early axSpA” and “early pSpA” in the research setting under the auspices of the Assessment of SpondyloArthritis international Society (ASAS).

Methods The ASAS-SPEAR (SPondyloarthritis EARly definition) steering committee convened an international working group (WG). Five consecutive steps were followed: i) Systematic literature review (SLR) to identify existing definitions of early axSpA/pSpA and to summarize the evidence on the relationship between early treatment and clinical response in SpA[1,2]; ii) Discussion of SLR results within the WG and ASAS community (2022 annual meeting); iii) A three-round Delphi survey (Apr-Nov 2022) inviting all ASAS members to select the items that should be considered for the definition of the terms (using a Likert scale 1-9). In total, 20 items relating to three different aspects (axial symptoms, duration of symptoms and radiographic damage involvement) were voted on. Consensus was defined as acceptance or rejection if ≥70% of responses fell within 7-9 or 1-3 on the Likert scale, respectively; iv) Presentation of Delphi survey results to the WG and later to the ASAS community; v) Final discussion, voting and endorsement by ASAS members (2023 annual meeting).

Results After discussing the results of the SLR[1,2] (step i) with the ASAS community, consensus was to proceed with an expert-based consensual definition for early axSpA (81% full ASAS members voted in favor) but not for pSpA (54% voted against) (step ii). Importantly, it was decided that the definition should be based on the symptom duration (91% in favor) taking solely axial symptoms into account (77% in favor). A total of 151-164/209 (72-78%) ASAS members participated in the Delphi survey rounds (step iii). Consensus was achieved to define early axSpA as a duration of symptoms of ≤2 years. Relating to axial symptoms, consensus was reached for acceptance of 6 items (axial symptoms should include cervical pain, thoracic pain, back pain, buttock pain and morning stiffness and be defined by a rheumatologist) and rejection of 2 items (should not include shoulder pain and hip pain). In addition, consensus was achieved to define early axSpA regardless of the presence/absence of radiographic damage (Table 1). Following the discussion of the Delphi survey results the WG agreed that in patients with a diagnosis of axSpA “early axSpA” should be defined as a duration of ≤2 years of axial symptoms. Axial symptoms should include spinal/buttock pain or morning stiffness and should be considered by a rheumatologist as related to axSpA, Figure 1. The WG proposal was discussed and endorsed by the ASAS community with 88% full ASAS members voting in favor (step v).

Conclusion Early axSpA has for the first time been defined based on expert consensus. This ASAS definition should be used in research studies addressing early axSpA.

References [1]Benavent D, et al. Semin Arthritis Rheum. 2022 Aug; 55:152032.

[2]Capelusnik D, et al. Rheumatology (Oxford). 2022 Sep 13:keac532.doi:10.1093.

Funding The Assessment of Spondyloarthritis international Society (ASAS) supported the ASAS- SPEAR (ASAS-SPondyloarthritis EARly definition) project.

View this table:
Table 1.

Delphi survey final results to select radiographic damage involvement items to define early axial spondyloarthritis.

Figure 1.
Figure 1.

ASAS definition of early axial spondyloarthritis

Acknowledgements The Assessment of Spondyloarthritis international Society (ASAS) supported the ASAS- SPEAR (ASAS-SPondyloarthritis EARly definition) project.

Disclosure of Interests Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharm, Consultant of: AbbVie, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis, Diego Benavent Consultant of: Janssen, Abbvie, and Galapagos, Grant/research support from: Novartis, Dafne Capelusnik: None declared, Désirée van der Heijde Shareholder of: Director of Imaging Rheumatology bv, Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Robert B.M. Landewé Shareholder of: Director of Rheumatology Consultancy BV, Consultant of: Consulting fees from AbbVie, Eli-Lilly, Janssen, Galapagos, Gilead, Novartis, Pfizer, UCB., Denis Poddubnyy Speakers bureau: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, UCB, Consultant of: AbbVie, Biocad, BMS, Eli Lilly, Gilead, MSD, Novartis, Pfizer, Samsung Bioepis, UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Astrid van Tubergen Speakers bureau: Pfizer, Consultant of: Novartis, Galapagos, UCB;, Grant/research support from: Pfizer, UCB, Novartis, Xenofon Baraliakos Speakers bureau: Abbvie, Amgen, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB., Consultant of: Abbvie, Amgen, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB., Grant/research support from: Abbvie, Amgen, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB., Filip van den Bosch Speakers bureau: speaker and/or consultancy fees from AbbVie, Amgen, Eli Lilly, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB, Consultant of: speaker and/or consultancy fees from AbbVie, Amgen, Eli Lilly, Galapagos, Janssen, Moonlake, Novartis, Pfizer and UCB, Floris A. van Gaalen Consultant of: fees from MSD, fees from Abb Vie, fees from Bristol Myers Squibb., Grant/research support from: grants from Stichting vrienden van Sole Mio, grants from Stichting ASAS, grant from Jacobus Stichting,grants and fees from Novartis, grants from UCB, Lianne S. Gensler Consultant of: AbbVie, Acelyrin, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, UCB Pharma, Grant/research support from: UCB, Novartis, Clementina López-Medina Speakers bureau: AbbVie, Eli Lilly, Novartis, Janssen, UCB Pharma, Consultant of: Eli Lilly, Novartis, UCB Pharma, Helena Marzo-Ortega Speakers bureau: Speaker fees and/or consultancy: ABvie, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer and UCB., Consultant of: Speaker fees and/or consultancy: ABvie, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer and UCB., Grant/research support from: Janssen, Novartis and UCB, Anna Moltó Consultant of: AbbVie, Biogen, BMS, Cyxone, Eisai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Grant/research support from: UCB, Rodolfo Perez Alamino Speakers bureau: Abbvie, Eli Lilly, Novartis, Janssen, Pfizer, Consultant of: Abbvie, Eli Lilly, Janssen, Novartis., Martin Rudwaleit Speakers bureau: AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer, UCB Pharma, Marleen G.H. van de Sande Speakers bureau: Janssen, Novartis, UCB, Consultant of: Abbvie, Eli Lilly, Novartis, UCB;, Grant/research support from: Eli Lily, Novartis, UCB, Raj Sengupta Speakers bureau: AbbVie, Biogen, Eli Lilly, MSD, Novartis, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis, UCB, Ulrich Weber Speakers bureau: Novartis, Sofia Ramiro Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, Sanofi, UCB, Grant/research support from: AbbVie, Galapagos, MSD, Novartis, Pfizer, U.

  • Spondyloarthritis

http://dx.doi.org/10.1136/annrheumdis-2023-eular.697

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