Estimation of the sensitivity and specificity of ASAS criteria for peripheral spondyloarthritis in patients with early psoriatic arthritis

Objective: to estimate the sensitivity and specificity of ASAS (Assessment of Spondyloarthritis International Society) criteria for peripheral spondyloarthritis (SpA) in patients with early psoriatic arthritis (ePsA).

Subjects and methods. Examinations was made in 45 patients (17 men and 28 women) with ePsA meeting the CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria (mean age, 37 years; disease duration, 1 year) and in 20 patients (9 men and 11 women) with signs of peripheral SpA meeting the ESSG (European Spondyloarthropathy Study Group) criteria (mean age, 23 years; disease duration, 2.25 years; control group). The investigators estimated 78/76 tender/swollen joints and enthuses using MASES (Maastricht Ankylosing Spondylitis Enthesitis Score) and assessed the presence of inflammatory spinal pain according to the ASAS criteria, psoriasis, uveitis, inflammatory bowel diseases, genitourinary and/or enteric infections, and a family history of SpA. They also performed X-ray studies of the hand and distal portions of the foot and pelvis and graded sacroilitis using the Kellgren scores. HLA-B27, C-reactive protein, and erythrocyte sedimentation rate were determined. The sensitivity/specificity, likelihood ratios, and clinical value of criteria were calculated.

Results. 41/4 and 31/14 patents with ePsA met/unmet Criteria Sets I and II. The sensitivity/specificity of Sets I and II was 91.1/10% and 68.8/95%, respectively. One patient with ePsA and two patients in the control group did not meet one of the sing sets. The total sensitivity/specificity was 97.8/10%. In the control group, the sensitivity/specificity of Sets I and II was 91.1/100% and 68.8/100%, respectively. For ePsA, the positive likelihood ratio proved to be high for Set II (13.78%) and low for Set I (1.01).

Conclusion. ASAS Criteria Set I for peripheral SpA is of low value in identifying ePsA and Sign Set II shows a high value in diagnosing ePsA as it includes the major clinical manifestations of the disease. Both the ASAS for peripheral SpA and CASPAR criteria may be used for the classification of PsA.

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