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The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward

  • Spondyloarthritis (MA Khan, Section Editor)
  • Published:
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Abstract

Classification criteria should facilitate selection of similar patients for clinical and epidemiologic studies, therapeutic trials, and research on etiopathogenesis to enable comparison of results across studies from different centers. We critically appraise the validity and performance of the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (axSpA). It is still debatable whether all patients fulfilling these criteria should be considered as having true axSpA. Patients with radiographically evident disease by the ASAS criteria are not necessarily identical with ankylosing spondylitis (AS) as classified by the modified New York criteria. The complex multi-arm selection design of the ASAS criteria induces considerable heterogeneity among patients so classified, and applying them in settings with a low prevalence of axial spondyloarthritis (SpA) greatly increases the proportion of subjects falsely classified as suffering from axial SpA. One of the unmet needs in non-radiographic form of axial SpA is to have reliable markers that can identify individuals at risk for progression to AS and thereby facilitate early intervention trials designed to prevent such progression. We suggest needed improvements of the ASAS criteria for axSpA, as all criteria sets should be regarded as dynamic concepts open to modifications or updates as our knowledge advances.

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Conflict of Interest

Sjef van der Linden: None

Nurullah Akkoc: Receipt of consultation fees, speaker’s bureau fees, and research funding from AbbVie, MSD, Pfizer, and UCB

Matthew A. Brown: Receipt of consultation fees, speaker’s bureau fees, and research funding from AbbVie, Janssen, Leo Pharma, Novartis, Pfizer, and UCB

Philip C Robinson: Receipt of consultation fees, speaker’s bureau fees, and research funding from AbbVie, Janssen, Pfizer, and UCB

Muhammad A Khan: Receipt of consultation fees and speaker’s bureau fees from AbbVie, Amgen, Novartis, Janssen, Celgene, and Crescendo Bioscience

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van der Linden, S., Akkoc, N., Brown, M.A. et al. The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward. Curr Rheumatol Rep 17, 62 (2015). https://doi.org/10.1007/s11926-015-0535-y

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