Comparison among Performances of Three Diagnostic Criteria for Patients with Seronegative Spondyloarthropath_West China Medical Journal

Authors：

LIU Lei , LIU Yixin , XIE Qibing ,  LIU Gang.

Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Gang., Email: liulei861204@163.com

Keywords：

性血清阴性脊柱关节病; 诊断; 分类标准

DOI：

10.7507/1002-0179.20130177

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

目的　探讨不同诊断或分类标准在脊柱关节病患者之间诊断效能、临床特点。方法　收集2000年2月－2012年8月141例脊柱关节病患者及197例类风湿关节炎、未分化关节炎患者资料。采用3种诊断标准下对141例患者分为纽约标准（NY）组、欧洲脊柱关节病研究（ESSG）组及脊柱关节病国际评估（ASAS）组，统计患者的临床表现、骶髂关节CT、MRI、实验室指标，并加入197例类风湿关节炎未分化关节炎患者，计算和比较3种诊断的敏感性、特异性。结果　在141例脊柱关节病中，62例符合NY标准，34例符合ESSG标准，45例只符合ASAS标准。3组患者在性别、胸廓受限、附着点炎及跖（指）炎、非甾体抗炎药及慢作用药使用、炎症因子水平方面差异无统计学意义（P＞0.05）；ASAS组则较19 NY组及ESSG组患者更年轻、病程较短，且表现有外周关节炎明显高于其余两组（P＜0.05）；NY组炎性腰背痛、脊柱活动受限、HLA-B27阳性率明显高于其余两组，且使用生物制剂比例最高，达48.38；在骨盆X线、骶髂关节CT表现关节侵蚀上，NY组较其他两组更严重。NY、ESSG、ASAS分类标准敏感性依次为43.97%、47.51%、73.76%，特异性依次为100.00%、90.86%、84.26%。结论　ASAS分类标准敏感性高，患者更年轻、病程更短，炎性腰背痛、外周关节炎是ASAS诊断中非常重要的指标；NY组脊柱活动受限及关节侵蚀最显著，HLA-B27阳性可能是预测AS很好的指标。NY标准特异性最高，敏感性最低，而ASAS标准敏感性最高，特异性最低。

Citation： LIU Lei,LIU Yixin,XIE Qibing,LIU Gang.. Comparison among Performances of Three Diagnostic Criteria for Patients with Seronegative Spondyloarthropath. West China Medical Journal, 2013, 28(4): 554-559. doi: 10.7507/1002-0179.20130177 Copy

1.	Sieper J, Rudwaleit M, Khan MA, et al. Concepts and epidemiology of spondy-loarthritis[J]. Best Pract Res Clin Rheumatol, 2006, 20(6): 401-417.
2.	Braun J, Bollow M, Remlinger G, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors[J]. Arthritis Rheum, 1998, 41(1): 58-67.
3.	Feldtkeller E, Khan MA, van der Heijde D, et al. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis[J]. Rheumatol Int, 2003, 23(3): 61-66.
4.	Rudwaleit M, van der Heijde D, Khan MA, et al. How to diagnose axial spondyloarthritis early[J]. Ann Rheum Dis, 2004, 63(5): 535-543.
5.	Dougados M, van der Linden S, Juhlin R, et al .The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy[J]. Arthritis Rheum, 1991, 34(10): 1218-1227.
6.	Sieper J, Rudwaleit M, Baraliakos X, et al . The Assessment of Spondylo arthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis [J] . Ann Rheum Dis, 2009, 68(6): 1-44.
7.	陆再英, 钟南山, 谢毅, 等. 内科学[M]. 7版, 北京：人民卫生出版社, 2008: 852-853.
8.	Chung HY, Lau CS, Wu KP, et al. Comparison of performance of the Assessment of Spondyloarthritis International Society, the European Spondyloarthropathy Study Group and the modified New York criteria in a cohort of Chinese patients with spondyloarthritis[J]. Clin Rheumatol, 2011, 30(7): 947-953.
9.	Brandt J, Khariouzov A, Listing J, et al . Six-month results of a double-blind, placebo controlledtrial of etanercept treatment in patients with active ankylosing Spondylitis[J]. Arthritis Rheum, 2003, 48(6): 1667-1675.
10.	van Tubergen A, Weber U. Diagnosis and classification in spondyloarthritis: identifying a chameleon[J]. Nat Rev Rheumatol, 2012, 8(3): 253-261.
11.	Feldtkeller E, Erlendsson J. Definition of disease duration in ankylosing spondylitis [J]. Rheumatol Int, 2008 , 28(4): 693–696.
12.	van den Berg R, van der Heijde DM. How should we diagnose spondyloarthritis according to the ASAS classification criteria[J]. Pol Arch Med Wewn, 2010, 120(11): 452-457.
13.	Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of Spondylo Arthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general [J] . Ann Rheum Dis, 2011, 70(1): 25-31.
14.	Kiltz U, Baraliakos X, Karakostas P, et al. The degree of spinal inflammation is similar in patients with axial spondyloarthritis who report high or low levels of disease activity: a cohort study[J]. Ann Rheum Dis, 2012, 71(7): 1207-1211.
15.	van den Berg R, van Gaalen F, van der Helm-van Mil A, et al. Performance of classification criteria for peripheral spondyloarthritis and psoriatic arthritis in the Leiden early arthritis cohort[J]. Ann Rheum Dis, 2012, 71(8): 1366-1369.
16.	Underwood MR, Dawes P. Inflammatory back pain in primary care [J]. Br J Rheumatol, 1995, 34(11): 1074-1077.
17.	Rudwaleit M. New approaches to diagnosis and classification of axial and peripheral spondyloarthritis[J]. Curr Opin Rheumatol, 2010, 22(4) : 375-380.
18.	Rudwaleit M, Metter A, Listing J, et al. Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history or application as classification and diagnostic criteria[J]. Arthritis Rheum, 2006, 54(2): 569-578.
19.	Liu X, Li YR, Hu LH, et al. High frequencies of HLA-B27 in Chinese patients with suspected of ankylosing spondylitis[J]. Rheumatol Int, 2010, 30(10): 1305-1309.
20.	Rudwaleit M, Jurik AG, Hermann KG, et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group[J]. Ann Rheum Dis , 2009, 68(10): 1520-1527.
21.	倪立青. 强直性脊柱炎的鉴别诊断[J]. 中国新药与临床杂志，1999, 18(11): 383-384.
22.	陶锡东. 强直性脊柱炎与腰椎间盘突出症鉴别体会[J]. 颈腰痛杂志, 2002, 23(2): 148-149.
23.	马树国, 武志峰. 强直性脊柱炎与致密性骨炎的CT鉴别诊断[J]. 实用医学影像杂志, 2002, 3(4): 280-281.
24.	Mathur T, Manadan AM, Hota B, et al. Pseudo-septic hip arthritis as the presenting symptom of ankylosing spondylitis: a case series and review of the literature [J] . Clin Exp Rheumatol, 2010, 28(3): 416-418.
25.	Bao J. Young males with primary lymphoma of bone presenting with musculoskeletal pain are prone to be misdiagnosed as ankylosing spondylitis: a case report[J]. Rheumatol Int, 2012, 32(1): 263-264.
26.	Davis JC Jr, Van der Heijde DM, Dougados M, et al. Baseline factors that influence ASAS 20 response in patients with ankylosing spondylitis treated with etanercept[J]. J Rheumatol, 2005, 32(9): 1751-1754.

1. 　Sieper J, Rudwaleit M, Khan MA, et al. Concepts and epidemiology of spondy-loarthritis[J]. Best Pract Res Clin Rheumatol, 2006, 20(6): 401-417.
2. 　Braun J, Bollow M, Remlinger G, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors[J]. Arthritis Rheum, 1998, 41(1): 58-67.
3. 　Feldtkeller E, Khan MA, van der Heijde D, et al. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis[J]. Rheumatol Int, 2003, 23(3): 61-66.
4. 　Rudwaleit M, van der Heijde D, Khan MA, et al. How to diagnose axial spondyloarthritis early[J]. Ann Rheum Dis, 2004, 63(5): 535-543.
5. 　Dougados M, van der Linden S, Juhlin R, et al .The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy[J]. Arthritis Rheum, 1991, 34(10): 1218-1227.
6. 　Sieper J, Rudwaleit M, Baraliakos X, et al . The Assessment of Spondylo arthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis [J] . Ann Rheum Dis, 2009, 68(6): 1-44.
7. 　陆再英, 钟南山, 谢毅, 等. 内科学[M]. 7版, 北京：人民卫生出版社, 2008: 852-853.
8. 　Chung HY, Lau CS, Wu KP, et al. Comparison of performance of the Assessment of Spondyloarthritis International Society, the European Spondyloarthropathy Study Group and the modified New York criteria in a cohort of Chinese patients with spondyloarthritis[J]. Clin Rheumatol, 2011, 30(7): 947-953.
9. 　Brandt J, Khariouzov A, Listing J, et al . Six-month results of a double-blind, placebo controlledtrial of etanercept treatment in patients with active ankylosing Spondylitis[J]. Arthritis Rheum, 2003, 48(6): 1667-1675.
10. 　van Tubergen A, Weber U. Diagnosis and classification in spondyloarthritis: identifying a chameleon[J]. Nat Rev Rheumatol, 2012, 8(3): 253-261.
11. 　Feldtkeller E, Erlendsson J. Definition of disease duration in ankylosing spondylitis [J]. Rheumatol Int, 2008 , 28(4): 693–696.
12. 　van den Berg R, van der Heijde DM. How should we diagnose spondyloarthritis according to the ASAS classification criteria[J]. Pol Arch Med Wewn, 2010, 120(11): 452-457.
13. 　Rudwaleit M, van der Heijde D, Landewé R, et al. The Assessment of Spondylo Arthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general [J] . Ann Rheum Dis, 2011, 70(1): 25-31.
14. 　Kiltz U, Baraliakos X, Karakostas P, et al. The degree of spinal inflammation is similar in patients with axial spondyloarthritis who report high or low levels of disease activity: a cohort study[J]. Ann Rheum Dis, 2012, 71(7): 1207-1211.
15. 　van den Berg R, van Gaalen F, van der Helm-van Mil A, et al. Performance of classification criteria for peripheral spondyloarthritis and psoriatic arthritis in the Leiden early arthritis cohort[J]. Ann Rheum Dis, 2012, 71(8): 1366-1369.
16. 　Underwood MR, Dawes P. Inflammatory back pain in primary care [J]. Br J Rheumatol, 1995, 34(11): 1074-1077.
17. 　Rudwaleit M. New approaches to diagnosis and classification of axial and peripheral spondyloarthritis[J]. Curr Opin Rheumatol, 2010, 22(4) : 375-380.
18. 　Rudwaleit M, Metter A, Listing J, et al. Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history or application as classification and diagnostic criteria[J]. Arthritis Rheum, 2006, 54(2): 569-578.
19. 　Liu X, Li YR, Hu LH, et al. High frequencies of HLA-B27 in Chinese patients with suspected of ankylosing spondylitis[J]. Rheumatol Int, 2010, 30(10): 1305-1309.
20. 　Rudwaleit M, Jurik AG, Hermann KG, et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group[J]. Ann Rheum Dis , 2009, 68(10): 1520-1527.
21. 　倪立青. 强直性脊柱炎的鉴别诊断[J]. 中国新药与临床杂志，1999, 18(11): 383-384.
22. 　陶锡东. 强直性脊柱炎与腰椎间盘突出症鉴别体会[J]. 颈腰痛杂志, 2002, 23(2): 148-149.
23. 　马树国, 武志峰. 强直性脊柱炎与致密性骨炎的CT鉴别诊断[J]. 实用医学影像杂志, 2002, 3(4): 280-281.
24. 　Mathur T, Manadan AM, Hota B, et al. Pseudo-septic hip arthritis as the presenting symptom of ankylosing spondylitis: a case series and review of the literature [J] . Clin Exp Rheumatol, 2010, 28(3): 416-418.
25. 　Bao J. Young males with primary lymphoma of bone presenting with musculoskeletal pain are prone to be misdiagnosed as ankylosing spondylitis: a case report[J]. Rheumatol Int, 2012, 32(1): 263-264.
26. 　Davis JC Jr, Van der Heijde DM, Dougados M, et al. Baseline factors that influence ASAS 20 response in patients with ankylosing spondylitis treated with etanercept[J]. J Rheumatol, 2005, 32(9): 1751-1754.

West China Medical Journal

Comparison among Performances of Three Diagnostic Criteria for Patients with Seronegative Spondyloarthropath

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content