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      Sex and gender differences in axial spondyloarthritis: myths and truths

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          Abstract

          Mounting evidence reveals evident sex differences in physiology, disease presentation and response to medication in axial SpA (axSpA). Unfortunately these data are often neglected in clinical practice and research. In this review, myths that still exist on diagnosis, disease manifestation and drug effectiveness were argued against data of the most recent literature. The aim is to increase awareness of sex differences in the clinical aspects of axSpA.

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          The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection.

          M Rudwaleit, D van der Heijde, R Landewé … (2009)
          To validate and refine two sets of candidate criteria for the classification/diagnosis of axial spondyloarthritis (SpA). All Assessment of SpondyloArthritis international Society (ASAS) members were invited to include consecutively new patients with chronic (> or =3 months) back pain of unknown origin that began before 45 years of age. The candidate criteria were first tested in the entire cohort of 649 patients from 25 centres, and then refined in a random selection of 40% of cases and thereafter validated in the remaining 60%. Upon diagnostic work-up, axial SpA was diagnosed in 60.2% of the cohort. Of these, 70% did not fulfil modified New York criteria and, therefore, were classified as having "non-radiographic" axial SpA. Refinement of the candidate criteria resulted in new ASAS classification criteria that are defined as: the presence of sacroiliitis by radiography or by magnetic resonance imaging (MRI) plus at least one SpA feature ("imaging arm") or the presence of HLA-B27 plus at least two SpA features ("clinical arm"). The sensitivity and specificity of the entire set of the new criteria were 82.9% and 84.4%, and for the imaging arm alone 66.2% and 97.3%, respectively. The specificity of the new criteria was much better than that of the European Spondylarthropathy Study Group criteria modified for MRI (sensitivity 85.1%, specificity 65.1%) and slightly better than that of the modified Amor criteria (sensitivity 82.9, specificity 77.5%). The new ASAS classification criteria for axial SpA can reliably classify patients for clinical studies and may help rheumatologists in clinical practice in diagnosing axial SpA in those with chronic back pain. NCT00328068.
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            Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria.

            S van der Linden, H Valkenburg, A Cats (1984)
            The New York and the Rome diagnostic criteria for ankylosing spondylitis (AS) and the clinical history screening test for AS were evaluated in relatives of AS patients and in population control subjects. The New York criterion of pain in the (dorso) lumbar spine lacks specificity, and the chest expansion criterion is too insensitive. The Rome criterion of low back pain for more than 3 months is very useful. Our study showed the clinical history screening test for AS to be moderately sensitive, but it might be better in clinical practice. As a modification of the New York criteria, substitution of the Rome pain criterion for the New York pain criterion is proposed.
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              The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general.

              M Rudwaleit, D van der Heijde, R Landewé … (2010)
              To evaluate new classification criteria for peripheral spondyloarthritis (SpA) in patients with SpA with peripheral manifestations only. In this Assessment of SpondyloArthritis international Society (ASAS) study, two prespecified sets of criteria were compared against the European Spondylarthropathy Study Group (ESSG) and Amor criteria in newly referred consecutive patients with undiagnosed peripheral arthritis, and/or enthesitis, and/or dactylitis that usually began before 45 years of age. The clinical diagnosis (SpA vs no SpA) made by the ASAS rheumatologist served as reference standard. In all, 24 ASAS centres included 266 patients, with a final diagnosis of SpA being made in 66.2%. After adjustments a final set of criteria showed the best balance between sensitivity (77.8%) and specificity (82.9%): arthritis and/or enthesitis and/or dactylitis plus (A) one or more of the following parameters: psoriasis, inflammatory bowel disease, preceding infection, human leucocyte antigen B27, uveitis, sacroiliitis on imaging, or (B) two or more other parameters: arthritis, enthesitis, dactylitis, inflammatory back pain in the past, family history of SpA. The new criteria performed better than modified versions of the ESSG (sensitivity 62.5%, specificity 81.1%) and the Amor criteria (sensitivity 39.8%, specificity 97.8%), particularly regarding sensitivity. In the entire ASAS population of 975 patients the combined use of ASAS criteria for axial SpA and ASAS criteria for peripheral SpA also had a better balance (sensitivity 79.5%, specificity 83.3%) than the modified ESSG (sensitivity 79.1%, specificity 68.8%) and Amor criteria (sensitivity 67.5%, specificity 86.7%), respectively. The new ASAS classification criteria for peripheral SpA performed well in patients presenting with peripheral arthritis, enthesitis and/or dactylitis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Rheumatology (Oxford)
                Journal ID (iso-abbrev): Rheumatology (Oxford)
                Journal ID (publisher-id): brheum
                Title: Rheumatology (Oxford, England)
                Publisher: Oxford University Press
                ISSN (Print): 1462-0324
                ISSN (Electronic): 1462-0332
                Publication date Collection: October 2020
                Publication date (Electronic): 14 October 2020
                Publication date PMC-release: 14 October 2020
                Volume: 59
                Issue: Suppl 4 , Axial spondyloarthritis: coming of age
                Pages: iv38-iv46
                Affiliations
                Department of Rheumatology, Amsterdam UMC, VU University Medical Center , Amsterdam, The Netherlands
                Author notes
                Correspondence to: Irene E. van der Horst-Bruinsma, Department of Rheumatology, Amsterdam UMC, VU University Medical Center, Room 3A-64, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: ie.vanderhorst@ 123456amsterdamumc.nl
                Author information
                http://orcid.org/0000-0001-8628-0119
                http://orcid.org/0000-0003-0075-4235
                http://orcid.org/0000-0002-8086-9915
                Article
                Publisher ID: keaa543
                DOI: 10.1093/rheumatology/keaa543
                PMC ID: 7566372
                PubMed ID: 33053194
                SO-VID: edf6d86f-4d9d-411d-87e1-ee4d0d7e5ad6
                Copyright © © The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 02 April 2020
                Date revision received : 24 July 2020
                Page count
                Pages: 9
                Funding
                Funded by: Novartis, DOI 10.13039/100004336;
                Categories
                Subject: Supplement Papers
                Subject: AcademicSubjects/MED00360

                ScienceOpen disciplines: Rheumatology
                Keywords: spondyloarthritis,biological therapies,epidemiology,inflammation,sex differences,patient reported outcomes
                Data availability:
                ScienceOpen disciplines: Rheumatology
                Keywords: spondyloarthritis, biological therapies, epidemiology, inflammation, sex differences, patient reported outcomes

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