Validation and reliability of translation of the ASAS Health Index in a Colombian Spanish-speaking population with spondyloarthritis.

To validate a Spanish language translation of the ASAS Heath-Index (ASAS-HI) testing, its reliability, construct validity, and responsiveness in Colombian patients with spondyloarthritis. Translation was done following a forward-backward procedure. Patients fulfilling the Assessment of Spondyloarthritis international Society (ASAS) criteria for either axial or peripheral spondyloarthritis (SpA) participated. Test-retest reliability was assessed by intra-class correlation coefficient (ICC) in patients without treatment changes. In patients who required a therapeutic intervention, responsiveness was assessed using the standardized response mean (SRM). Construct validity was evaluated by Spearman correlation. Internal consistency (Cronbach's α) and discriminative ability of the ASAS-HI were assessed. Fifty patients were included: 54% male, mean (SD) age 44.8 (13.1), symptom duration 15.8 (9.7) years, Bath Ankylosing Spondylitis Disease Index (BASDAI) 4.6 (2.2), Bath Ankylosing Spondylitis Functioning Index (BASFI) 4.7 (2.5), Ankylosing Spondylitis Disease Activity Score with C-Reactive Protein (ASDAS-CRP) 2.2 (1.0). Axial SpA was established in 44 patients (ankylosing spondylitis (AS) = 30, non-radiographic axial SpA (nr-axSpA) = 14) and peripheral SpA in 6 patients. The score of the ASAS-HI was 8.2 (5.1). The test-retest reliability was good with an ICC of 0.84. SRM was 2.58 (1.75-3.37) in 10 patients with any intervention and 2.94 (2.13-4.24) for 7 patients starting TNF blockers. Construct validity showed a good correlation between ASAS-HI and pain, BASDAI, BASFI, and Ankylosing Spondylitis Disease Activity Score (ASDAS) (r ≥ 0.60). A high internal consistency was found with a Cronbach's α of 0.91. ASAS-HI discriminated well between patients with different stages of disease activity (BASDAI and ASDAS). Those with higher disease activity had higher ASAS-HI scores. The Spanish language translation of the ASAS-HI has proven to be psychometrically valid for Colombian patients with SpA. This version is available to evaluate the state of health and functioning in these patients and can be used in clinical practice.

Factors associated with the decision of the rheumatologist to order sacroiliac joints magnetic resonance imaging (SI-MRI) or HLA-B27 testing in the diagnostic work-up of patients with spondyloarthritis in clinical practice.

OBJECTIVES: To evaluate the patients' characteristics associated with the clinical decision to request SI-MRI and/or HLA-B27 in patients with SpA in daily practice. METHODS: Patients referred to a rheumatology outpatient-clinic in a national referral-centre were selected. Patients with a clinical diagnosis of SpA according to the rheumatologist were included. SI-MRI and HLA-B27 was available for patients in whom the rheumatologists had ordered these tests. Characteristics associated with ordering SI-MRI or HLA-B27 were identified with univariable analyses. Variables with p-value <0.05 and >80% completeness were selected for further analysis. A multivariable logistic regression analysis was used to evaluate the determinants related with the decision to perform SI-MRI and/or HLA-B27 and odds ratios with 95% confidence intervals were calculated. RESULTS: In total, 581 patients with SpA were included in the cohort, 72% were men, mean age 34.6±12.1 and disease duration 7.3±9.7 years. Of these patients, 24% (n=137) had SI-MRI and 77% (n=441) had HLA-B27 tests ordered. Independently predictive factors for ordering a SI-MRI were the presence of IBP (OR=1.81), enthesitis (OR=1.57) and the number of initial-symptoms at presentation (OR=1.27 per additional symptom present). Independently predictive factors of HLA-B27 testing were the number of initial-symptoms (OR=1.45 per symptom) and uveitis (OR=3.19). CONCLUSIONS: This study strongly suggests that rheumatologists use certain clinical clues to decide if they order expensive and scarce tests in the diagnostic work-up of SpA patients. These manifestations may increase the efficiency of these tests in clinical practice and suggest that clinical reasoning follows principles of Bayesian theory.

Analysis and performance of various classification criteria sets in a Colombian cohort of patients with spondyloarthritis.

The objective of this study was to investigate the performance of classification criteria sets (Assessment of SpondyloArthritis international Society (ASAS), European Spondylarthropathy Study Group (ESSG), and Amor) for spondyloarthritis (SpA) in a clinical practice cohort in Colombia and provide insight into how rheumatologists follow the diagnostic path in patients suspected of SpA. Patients with a rheumatologist's diagnosis of SpA were retrospectively classified according to three criteria sets. Classification rate was defined as the proportion of patients fulfilling a particular criterion. Characteristics of patients fulfilling and not fulfilling each criterion were compared. The ASAS criteria classified 81 % of all patients (n = 581) as having either axial SpA (44 %) or peripheral SpA (37 %), whereas a lower proportion met ESSG criteria (74 %) and Amor criteria (53 %). There was a high degree of overlap among the different criteria, and 42 % of the patients met all three criteria. Patients fulfilling all three criteria sets were older (36 vs. 30 years), had more SpA features (3 vs. 1 features), and more frequently had a current or past history of back pain (77 vs. 43 %), inflammatory back pain (47 vs. 13 %), enthesitis (67 vs. 26 %), and buttock pain (37 vs. 13 %) vs. those not fulfilling any criteria. HLA-B27, radiographs, and MRI-SI were performed in 77, 59, and 24 % of the patients, respectively. The ASAS criteria classified more patients as having SpA in this Colombian cohort when the rheumatologist's diagnosis is used as an external standard. Although physicians do not perform HLA-B27 or imaging in all patients, they do require these tests if the clinical symptoms fall short of confirming SpA and suspicion remains.