比较各种SpA分类标准

 

原文

译文

FRI0508

PERFORMANCES (INCLUDING POSITIVE AND NEGATIVE PREDICTIVE VALUES) OF SPONDYLOARTHRITIS (SPA) SETS OF CRITERIA IN PATIENTS VISITING A RHEUMATOLOGIST BECAUSE OF CHRONIC BACK PAIN: PRELIMINARY RESULTS OF DECLIC STUDY.

M. DOUGADOS ^1,*, S. PATERNOTTE ¹, D. COMET ², C. HACQUARD-BOUDER ³, M. RUDWALEIT ⁴, P. CLAUDEPIERRE ⁵, D. Van der HEIJDE ⁶

¹HOPITAL COCHIN , RENÉ DESCARTES UNIVERSITY, ²Axonal, ³Abbott laboratories, PARIS, France, ⁴La Charité University, Berlin, Germany, ⁵Hopital Henri Mondor, Créteil University, Créteil, France, ⁶Leiden University, Leiden, Netherlands

 

Background: ASAS (Assessment in SpondyloArthritiS) has recently proposed new sets of criteria for axial SpA. Such sets of criteria were performing at least as well as or better than the conventional Amor and ESSG criteria in the population of patients recruited for the study aimed at validating these criteria

Objectives: To evaluate the different psychometric properties (e.g. sensitivity (Se), specificity (Spe) but also positive (PPV) and negative (NPV) predictive values) in patients with chronic back pain in rheumatology daily practice.

Methods: Study design: cross-sectional, multi-centre, epidemiological study. Patients: chronic (≥3 months) back pain which has occurred before the age of 45 years and after the year of 1995 visiting a rheumatologist in France. Data collected: a) all the items included in the ASAS, AMOR, ESSG and modified New York (mNY) criteria checking whether they were present at the time of the diagnosis was made. Moreover, sacroiliitis detected by either X-Rays or MRI  defined the so-called “modified” Amor and ESSG criteria b) the diagnosis of the rheumatologist at the time of the study visit (e.g. SpA versus other diseases such as mechanical back pain considered as controls for this study). Statistical analysis: rheumatologist’s diagnosis was considered as the “gold standard”, the absence of information related to either imaging (e.g. pelvic X-Rays, MRI) or biology (e.g.  HLA B27, CRP) at the time of diagnosis  was considered  as “normal” in  the evaluation of  the performances (e.g. Se, Spe, PPN, NPV) of the different  sets of criteria

Results: On November 1^st 2010, 163 rheumatologists recruited 472 patients (161 SpA (34%) and 311 controls) with the following characteristics: age: 39.4±10.8 versus 44.1±11.1 years, female sex: 43.5% versus 46.6%, disease duration: 8.6±7.4 versus 7.3±5.3 years in the SpA versus controls groups respectively. At the time of diagnosis of SpA, sacro-iliitis at plain X-rays was present in 71/161 patients (44.1%). In 49 of the remaining 90 patients, MRI was performed for diagnostic purpose and showed signs suggestive of SpA in 33 (42.3%). The table summarizes the performances of the different sets of criteria.

Conclusions: These preliminary data suggest that:

1 the prevalence of SpA in patients suffering from chronic low back pain before the age of 45 and visiting a rheumatologist in France is high

2 the performances of the different sets of SpA are good and better than the mNY for Ankylosing Spondylitis at the time of the presentation of the patients to a rheumatologist ( diagnostic purpose)

3 In this condition, the best scores were obtained by both the (modified) Amor and ASAS axial SpA criteria

References: This study was supported by an unrestricted grant from ABBOTT France

Sets of criteria	Se	Spe	PPV	NPV
mNY Amor ESSG ASAS axial SpA   Modified Amor Modified ESSG	0.27 0.70 0.60 0.71   0.74 0.65	0.99 0.96 0.94 0.96   0.96 0.94	0.94 0.90 0.83 0.91   0.90 0.84	0.72 0.86 0.82 0.87   0.88 0.84

 

比较各种SpA分类标准

M. DOUGADOS ^1,*, EULAR 2011. Present No:FRI0508

 

背景:ASAS(脊柱关节炎的评价工作组)最近提出了中轴型SpA的新标准。 为验证这一标准,本研究对纳入的患者进行各种诊断标准的比较,发现这套新标准至少不差于传统Amor和ESSG标准。

 

目的:评价日常风湿病实践中慢性背部疼痛患者的心理特性(如灵敏度(Se),特异性(Spe)，以及阳性(PPV)和阴性(NPV)预测值)。

方法:研究设计:横断面、多中心的流行病学研究。患者:慢性(≥3个月)背部疼痛出现在45岁以前,并且在1995年以后就诊于法国风湿病医生。数据收集:a) 确认ASAS，AMOR，ESSG和改良的纽约(mNY)标准中包括的所有表现在初次诊断时是否就已经出现。此外, X线或MRI检测的骶髂关节炎按照“改良”Amor和ESSG定义 b)本研究中风湿病医生就诊时的诊断 (如， SpA，或其他疾病如机械性背痛作为研究对照)。

统计分析:风湿病医生的诊断被视为"金标准",在诊断时标准中缺失的其他相关资料(如，骨盆x射线，MRI)或生物学指标(如HLA- B27,CRP)在评估时被视为“正常” (如，Se，Spe，PPN，NPV)。

结果:至 2010年11月1日, 163名风湿科医生共招募了472例患者(161例 SpA(34%)和311例对照)，两组患者的特点如下:年龄分别为39.4±10.8与44.1±11.1年,女性比例为43.5%与46.6%,病程分别为8.6±7.4与7.3±5.3年。71/161患者(44.1%)在诊断SpA时X线片上有骶髂关节炎表现。其他90例患者中有49例为明确诊断进行了核磁共振成像(MRI)检查，33(42.3%)提示有SpA征象。表中总结了不同标准的情况。

结论:这些初步的数据提示:

1 法国45岁以下因为慢性腰背痛就诊风湿科医生的患者SpA患病率是相当高的。

2患者就诊风湿病医生时不同的SpA诊断标准应用性较好，并优于强直性脊柱炎的mNY标准（诊断目的)

3在此情况下,（改良的）Amor和ASAS中轴型SpA的标准得分最好。

不同标准	Se	Spe	PPV	NPV
mNY Amor ESSG ASAS 中轴型SpA   改良Amor 改良ESSG	0.27 0.70 0.60 0.71   0.74 0.65	0.99 0.96 0.94 0.96   0.96 0.94	0.94 0.90 0.83 0.91   0.90 0.84	0.72 0.86 0.82 0.87   0.88 0.84