在早期IBP病人中比较风湿病医生诊断中轴型SpA(aSpA)与非aSpA

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OP0046 COMPARISON OF AXIAL SPONDYLARTHROPATHY (ASPA) AND NON ASPA PATIENTS RHEUMATOLOGIST DIAGNOSIS AMONG AN RECENT INFLAMMATORY BACK PAIN PATIENTS COHORT – THE DESIR COHORT M.-A. Lanfranchi Debra 1,*, F. Tubach 2, A. Lombard 2, M. Rudwaleit 3, P. Lafforgue 1, T. Pham 4 1APHM, Marseille, 2APHP, Paris, France, 3Charité-University, Berlin, Germany, 4Rheumatology, APHM, Marseille, France   Background: The ASAS (Assessement of SpondyloArthritis international society) has recently proposed new classification criteria that can reliably classify patients for clinical studies but also for helping rheumatologists in clinical practice in diagnosing AS among those with chronic back pain. Objectives: The aim of our study was a) to describe aSpA and non aSpA patients according to rheumatologists diagnosis in an inflammatory back pain population before implementation and dissemination of the new ASAS classification criteria and b) to assess the performance of different existing classification criteria for the diagnosis of AS (using rheumatologists’ diagnosis as gold standard). Methods: Patients: The DESIR cohort is a prospective longitudinal national French cohort of early inflammatory back pain (IBP) patients. Inclusion criteria were: age between 18 and 50, IBP fulfilling Berlin or Calin criteria, duration over 3 months and less than 3 years. After a standardized consultation, rheumatologists were asked whether the patient had aSpA or not. They also graded their diagnosis confidence on a 0-10 scale. Analysis: Univariate and multivariate analysis (logistic regression) aimed at identifying parameters associated to aSpA diagnosis. The level of confidence was considered as a continuous variable. Sensitivity, specificity and positive likelihood ratio (LR) were calculated for the different classification criteria (ESSG, Amor, ASAS), using the rheumatologists’ diagnosis as gold standard. Results: Among 692 IBP patients, 341 were diagnosed aSpA (49.2%) of whom 53.8% had MRI sacroiliitis, 34.3% X-Rays sacroiliitis, 69.2%, 80.1% and 78.3% fulfilled Amor, ESSG and ASAS criteria (ASAS "sacroiliitis" 51.0%, ASAS "B27" 68.9%). The median diagnosis confidence was 8.0 (IQR = 7.0 – 9.0). Four parameters were associated to aSpA diagnosis: improvement after NSAID intake, psoriasis, HLA B27 and sacroiliitis. Because MRI sacroiliitis and X-rays sacroiliitis were highly correlated, we assessed parameters performances in 2 different models. Model 1 (without X-Rays sacroiliitis): improvement after NSAID intake: OR [CI95%]: 1.58 [1.03 - 2.44] (p=0.037), psoriasis: 0.42 [0.27 - 0.68](p=0.0003), HLA B27: 2.35 [1.66 - 3.33] (p<0.0001) and MRI sacroiliitis: 2.40 [1.70 - 3.39] (p<0.0001). Model 2 (without MRI sacroiliitis) results were similar, with X-rays sacroiliitis OR = 2.80 [1.72 - 4.56] (p<0.0001). ASAS criteria had the best performance for aSpA diagnosis with positive LR 1.36 [CI95%: 1.2-1.5] vs 1.10 [0.9-1.2] and 1.06 [0.9-1.1] for Amor and ESSG criteria, respectively. ASAS, Amor and ESSG criteria sensitivity/specificity were: 78.3/42.4%, 69.2%/37.0% and 80.1%/24.5%, respectively. Conclusions: Four parameters are associated to the rheumatologist’ diagnosis of aSpA in an early IBP population: improvement after NSAID intake, lack of psoriasis, HLA B27 and sacroiliitis on X-Rays or MRI. ASAS criteria were most relevant than Amor and ESSG in diagnosing aSpA in this population. However, classification criteria seemed to have a poor specificity among this early IBP population.

在早期IBP病人中比较风湿病医生诊断中轴型SpA(aSpA)与非aSpA   Lanfranchi Debra M, et al. EULAR 2011. Present No: OP0046.     背景：国际脊柱关节炎评估协作组（ASAS）最近提出了新的分类标准，能够可靠地筛选出适于临床试验的病人，同时也在临床实践中帮助风湿病医生鉴别哪些慢性背痛患者属于强直性脊柱炎(AS)。 目标：本研究将要探讨a）在制订和发布ASAS新版标准之前，依据风湿病医生诊断为中轴型SpA（aSpA）和非aSpA病人的情况；b）评估现有的不同AS分类标准的性能（以风湿病医生的诊断作为金标准）。 方法：患者：DESIR队列是一项针对法国早期炎性背痛(IBP)病人的前瞻性纵向观察队列。入选标准：18岁至50岁之间，IBP诊断采用柏林或卡林标准，病程为3个月至3年。经过一个标准化的咨询后，再询问风湿病医生该病人是否是aSpA。医生们还将诊断信心进行分级（0-10）。分析：采用单变量和多变量分析（逻辑回归）以确定与aSpA诊断关联的参数。诊断信心被视为一个连续变量。还将计算不同分类标准（ESSG、Amor和ASAS）的敏感性、特异性和阳性似然比（LR），以风湿病医生的诊断作为金标准。 结果：在692例IBP病人中，341个被确诊aSpA（49.2％），其中53.8％的病人有MRI证实的骶髂关节炎，34.3％的病人有X线证实的骶髂关节炎，符合Amor、ESSG和ASAS标准的病人比例分别为69.2％、80.1％和78.3％（符合ASAS分类标准中“骶髂关节炎”分支和”HLA-B27”分支的病人比例分别为51.0％和68.9％）。诊断信心的中位数为8.0（IQR：7.0 - 9.0）。 与SpA诊断相关的参数有四个：NSAIDs有效、银屑病、HLA-B27阳性以及骶髂关节炎阳性。由于MRI骶髂关节炎与X线骶髂关节炎的高度相关性，我们使用2个不同模型来检验参数性能。模型1（无X线骶髂关节炎）：NSAIDs有效的OR(95％CI)为1.58[1.03 - 2.44]（P = 0.037），银屑病为0.42[0.27 - 0.68]（P = 0.0003），HLA-B27为2.35[1.66 - 3.33]（P <0.0001），MRI骶髂关节炎为2.40[1.70 - 3.39]（P <0.0001）。模型2（无MRI骶髂关节炎）的结果与模型1相似，X线骶髂关节炎为2.80[1.72 - 4.56]（P <0.0001）。 aSpA诊断性能最佳者为ASAS分类标准，其LR为1.36 [95％CI：1.2-1.5]，而Amor标准和ESSG标准分别为1.10[0.9-1.2]和1.06[0.9-1.1]。ASAS、Amor和ESSG标准的敏感性/特异性分别为78.3/42.4％、69.2％/37.0％和80.1％/24.5％。 结论：在早期IBP人群中，与风湿病医生诊断aSpA相关联的四个参数是：NSAIDs有效、无银屑病、HLA-B27阳性以及X线骶髂关节炎。在这个人群中，ASAS标准与aSpA诊断的相关性高于Amor标准以及ESSG标准。然而，在这组早期IBP人群中，各分类标准的特异性较差。