New Classification Criteria for Juvenile Axial Spondyloarthritis Save

An expert panel has published new and validated classification criteria for axial disease in children with juvenile spondyloarthritis (SpA; AxJSpA).

The authors used a systematic literature review to evaluate the discriminatory value of 108 items. Following a delphi method this was narrowed to 37 items for testing.  

In the end, final AxJSpA criteria domains included: imaging: active inflammation, imaging: structural lesions, pain chronicity, pain pattern, pain location, stiffness, and genetics. Amongst these active inflammation and structural lesions on imaging were most heavily weighted. 

Importantly, sacroiliitis was deemed important, if not necessary, but not sufficient, to classify a youth with AxJSpA. The threshold for classification of AxJSpA was a score of ≥55 (out of 100). Final criteria had a specificity of 97.5%, sensitivity of 64.3% and Area Under the Receiver Operating Characteristic (AUROC) curve of 0.81.

These new AxJSpA classification criteria require an entry criterion, physician diagnosis of juvenile SpA in patient who areless than 18 years old at onset of axial symptoms. 

The criteria consist of 7 domains, 1 genetic, 4clinical and 2 imaging. By comparison to the AxJSpA criteria, lowerspecificity and AUROC were observed with the ILAR ERA criteria, ILAR ERA definition ofsacroiliitis, ASAS axial and peripheral SpA, and ESSG criteria for adults.

Criteria Domains, Items and Scoring (>55 needed)