Welcome to SpA SIG
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Transcript of Welcome to SpA SIG
Welcome to SpA SIG
August 2, 2006
MR 304 : 15.30-16.30
How you diagnose and assess disease activity in AS:
Results of a questionnaire study
Ratanavadee Nanagara, M.D.Allergy-Immunology-Rheumatology Unit
KhonKaen University
Thailand
parameters being used in common practice fordiagnosis and assessment of AS patients.
comments, suggestion, and revised by experience AS researchers
80 parameters for AS diagnosis, 32 for AS assessment
electronically distributed
Questionnaire
to assess the degree of importance of …parameters used for diagnosis and assessment of AS patients …
*** rheumatologist running clinical practice for at least 5-10 years
….. up to the individual opinion.. used in clinical practice, not in research….
* each item was scored as 1 or 2 or 3. 1 = not important2 = moderate important3 = extremely important
Purpose
“The must”
Australia (1) Lionel Schachna Hongkong (4) Isaac YIM, Cheuk-wanLai Shan TamLau Chak SingLee Ka Wing
India (4) Ashok KumarRohini HandaVed ChaturvediVikas Agarwal
Indonesia (1) John Darmawan
Korea (3) Sang-Hoon, Lee.Tae-Hwan KimTae Jong Kim
Malaysia (4) Gun Suk ChynLew LWGSwan Sim YeapSwee Gaik Ong
Philippines (4) Evelyn SalidoJuan Javier LichaucoJulie Li YuSandra V. Navarra
Singapore (5) Anita LimChew Li-ChingJulian ThumbooKok Ooi KongSpore Bernard Thong
Taiwan (1) Chung-Tei Chou
Thailand (4) Boonjing SiripaitoonRatanavadee NanagaraSittichai UkritchonWorawit Laoraenu
31 responders
from 10 APLAR countries
Results analysis
> 80% of responders scored as important ( 2 + 3)
Parameter for diagnosis
including: CRP, ESR, most plain films, and MRI 70% agree with B-27 study, less with RF
Parameter for assessment
Including: VAS, BASFI, BASDAI, GA, +BASMI
43 / 57 clinical parts
29 / 32 items listed
9 / 23 Lab. tests
> 80% of responders scored as “The Must” (3)
433 / 57 clinical parts
Parameter for diagnosis
film pelvis9 1 / 23 Lab. tests
Schober test
Inflammatory back pain, morning pain, Schober test
Parameter for assessment
29 1 / 32 items listed
> 60% of responders scored as “The Must” (3)
433 10 / 57 clinical parts
Parameter for diagnosis
film pelvis91 1 / 23 Lab. tests
Schober, morning painperipheral joints & eye exam,VAS (pain, global), BASDAI,
back pain characteristics eye sign, sausage digitschest expansion
Parameter for assessment
291 6 / 32 items listed50-60 % scored for chest expansion, enthesitis BASFI, CRP, ESR
50% scored for MRI, 30% scored for B-27
Conclusion (1)
1. Majority of the responders agree that most parameters used for
diagnosis and assessment of AS patients are important.
2. However, limited numbers of these parameters have been using
in their clinical practice.
3. At least, characteristics of back pain, Schober test, chest and
eye exam, and film pelvis were evaluated by 80% of the
responders.
4. About half used MRI of SI joint for AS diagnosis, while one
third need genetic study.
5. Half of the responders used AS measurement parameters
(BASDAI, BASFI, VAS) and inflammatory parameters (CRP, ESR) during
AS assessment for their optimal care.
Conclusion (2)
15:30-15:42 How APLAR countries can contribute to international research
David YU USA
15:42-15:54 How you diagnose and assess disease activity in AS, results of a questionnaire study
Ratanavadee Nanagara Thailand
15:54-16:06 Are UspA and AS 2 different diseases? Result from cohort study
Chung-Tei Chou Taiwan
16:06-16:18 Towards a perfect epidemiological Study of SpA, experience in China
Swee Cheng Ng Singapore
16:18-16:30 Do UspA patients respond to TNF blockersJieruo Gu China
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
History not imp. must
Gender 25.8 45.2 29.0 74.2
Age 9.7 51.6 38.7 90.3
Ethnicity 58.1 22.6 19.4 41.9
Family history of SpA 3.2 41.9 54.8 96.8
Family history of psoriasis or IBD or iritis 6.5 51.6 41.9 93.5
History of HLA-B27 in family members 19.4 58.1 22.6 80.6
Age of onset of symptoms of AS 3.2 48.4 45.2 93.5
> 50% used in clinical practice
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
History not imp. must
History of preceding diarrhea or genital discharge or balanitis 12.9 51.6 35.5 87.1
History of preceding injury 71.0 22.6 6.5 29.0
History of psoriasis 6.5 48.4 45.2 93.5
History of IBD 0.0 54.8 45.2 100.0
History of iritis 0.0 32.3 67.7 100.0
History of buttock pain 0.0 25.8 74.2 100.0
Whether buttock pain is alternating 32.3 32.3 35.5 67.7
Whether patient is waken up by night pain 9.7 19.4 71.0 90.3
> 50% used in clinical practice > 70%
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
History not imp. must
History of cervical spinal pain 22.6 35.5 41.9 77.4
History of thoracic spinal pain 22.6 35.5 41.9 77.4
History of lumbar spinal pain 6.5 35.5 58.1 93.5
Whether spinal pain is "inflammatory" by Calin definition 0.0 6.5 93.5 100.0
Age of onset of spinal pain before age 40 3.2 25.8 71.0 96.8
Whether onset of spinal pain is insidious 12.9 51.6 35.5 87.1
Duration of spinal pain if it is more than 3 months 9.7 32.3 58.1 90.3
> 50% used in clinical practice > 70%
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
History not imp. must
Whether spinal pain is improved by exercise 3.2 25.8 71.0 96.8
Whether there is morning stiffness of spine 3.2 9.7 87.1 96.8
Whether spinal pain is improved by rest 25.8 25.8 48.4 74.2
Whether spinal pain is relieved by NSAIDs 19.4 41.9 38.7 80.6
Presence of peripheral joint pain 6.5 48.4 45.2 93.5
Presence of peripheral joint stiffness 9.7 54.8 35.5 90.3
Whether peripheral joint pain is oligo in number, asymmetrical and predominantly in lower extremities 6.5 45.2 48.4 93.5
> 50% used in clinical practice > 70%
Parameters used in diagnosis of AS S1% S2% S3% 2+3%
History not Imp. must
Presence of pain in shoulders 22.6 58.1 16.1 74.2
Presence of pain in hips 3.2 48.4 48.4 96.8
Presence of pain at heels 6.5 41.9 51.6 93.5
History of sausage digits 6.5 32.3 61.3 93.5
Presence of rib cage and anterior chest wall pain 19.4 45.2 35.5 80.6
History of skin rash on any parts of the body 22.6 51.6 25.8 77.4
History of HLA-B27 blood test in patient 22.6 48.4 29.0 77.4
> 50% used in clinical practice
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
Physical examination not Imp. must
Gait 19.4 48.4 16.1 64.5
Presence of abnormal posture 9.7 48.4 41.9 90.3
Occiput to wall distance 9.7 45.2 45.2 90.3
Tragus to wall distance 12.9 48.4 38.7 87.1
Degree of cervical rotation 6.5 51.6 41.9 93.5
Degree of cervical lateral rotation 12.9 51.6 35.5 87.1
Schober test for forward flexion of lumbar spine 0.0 9.7 87.1 96.8
Lateral flexion of lumbar spine 16.1 41.9 41.9 83.9
Finger to floor distance 25.8 48.4 25.8 74.2
> 50% used in clinical practice > 70%
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
Physical examination not Imp. must
Intermalleolar distance 35.5 48.4 16.1 64.5
Measurement of chest expansion 6.5 29.0 64.5 93.5
Presence of sausage digits 9.7 32.3 58.1 90.3
Swelling of peripheral joints 3.2 48.4 48.4 96.8
Tenderness of peripheral joints 6.5 58.1 35.5 93.5
Swelling of heels 12.9 29.0 58.1 87.1
Tenderness of heels 6.5 45.2 48.4 93.5
> 50% used in clinical practice
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
Physical examination not Imp. must
Range of motion of shoulders and hips 6.5 51.6 41.9 93.5
Physical exam for active sacroiliitis e.g. Patrick test 9.7 41.9 48.4 90.3
Physical exam for skin abnormalities 16.1 48.4 35.5 83.9
Physical exam for redness or swelling of eyes 6.5 48.4 45.2 93.5
Auscultation for aortic insufficiency 41.9 32.3 25.8 58.1
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
Laboratory diagnosis not Imp. must 0.0
WBC 71.0 16.1 9.7 25.8
Differential wbc count 77.4 16.1 6.5 22.6
Hgb 45.2 38.7 16.1 54.8
Platelet count 45.2 35.5 19.4 54.8
Urine analysis 54.8 25.8 19.4 45.2
Standard blood chemistry 61.3 22.6 16.1 38.7
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
Genetic & Serologic tests not Imp. must 3.2
HLA-B27 25.8 41.9 29.0 71.0
Rheumatoid factor 64.5 22.6 12.9 35.5
ANA 77.4 12.9 9.7 22.6
ESR 3.2 41.9 54.8 96.8
CRP 3.2 45.2 48.4 93.5
> 50% used in clinical practice
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
Radiographic evaluation not Imp. must
X-ray of pelvis for sacroiliitis 0.0 6.5 93.5 100.0Scoring of the degree of sacroiliitis 12.9 35.5 51.6 87.1
CT of sacroiliac joints 25.8 38.7 35.5 74.2
MRI of sacroiliac joints 16.1 32.3 51.6 83.9
MRI of spine 35.5 45.2 19.4 64.5
X-ray of hips 12.9 54.8 32.3 87.1
> 50% used in clinical practice > 70%
Parameters used in diagnosis of AS S1%
S2%
S3%
2+3%
Radiographic evaluation not Imp. must 0.0
Bone scan 41.9 45.2 12.9 58.1
X-ray of spine: cervical 19.4 51.6 29.0 80.6
X-ray of spine: thoracic 16.1 58.1 25.8 83.9
X-ray of spine: lumbar 9.7 38.7 51.6 90.3
Ultrasound 80.6 9.7 9.7 19.4
Bone density assessment 48.4 35.5 9.7 45.2
> 50% used in clinical practice
Parameters used in assessment of AS S1%
S2%
S3%
2+3%
Occupation 19.4 38.7 41.9 80.6
Whether occupation if physically demanding 12.9 45.2 41.9 87.1Whether the patient has to take sick leave for his arthritis 9.7 51.6 38.7 90.3
Patient global assessment VAS 3.2 29.0 67.7 96.8
Degree of fatigue 19.4 51.6 29.0 80.6
BASDAI score 12.9 22.6 64.5 87.1
> 50% used in clinical practice
Parameters used in assessment of AS S1%
S2%
S3%
2+3%
Degree of peripheral joint pain in a VAS scale 22.6 35.5 41.9 77.4
Degree of spinal pain in a VAS scale 12.9 22.6 64.5 87.1
Degree of morning stiffness in a VAS scale 6.5 35.5 58.1 93.5
Duration of morning stiffness 6.5 16.1 77.4 93.5
BASFI score or other functional scoring systems 9.7 35.5 54.8 90.3
Other health questionnaires 29.0 51.6 16.1 67.7Physician global assessment on a scale of 0-4 or 0-10 16.1 51.6 32.3 83.9
> 50% used in clinical practice > 70%
Parameters used in assessment of AS S1%
S2%
S3%
2+3%
Occiput to wall distance 3.2 58.1 38.7 96.8
Tragus to wall distance 12.9 41.9 45.2 87.1
Degree of cervical rotation 6.5 51.6 41.9 93.5
Degree of cervical lateral rotation 12.9 58.1 29.0 87.1Schober test for forward flexion of lumbar spine 3.2 12.9 83.9 96.8
Lateral flexion of lumbar spine 12.9 51.6 35.5 87.1
Finger to floor distance 9.7 61.3 29.0 90.3
Intermalleolar distance 25.8 51.6 22.6 74.2
Measurement of chest expansion 6.5 35.5 58.1 93.5
> 50% used in clinical practice > 70%
Parameters used in assessment of AS S1%
S2%
S3%
2+3%
Presence of sausage digits 6.5 38.7 54.8 93.5
Swelling of peripheral joints 0.0 29.0 71.0 100.0
Tenderness of peripheral joints 0.0 58.1 41.9 100.0
Swelling of heels 12.9 35.5 51.6 87.1
Tenderness of heels 9.7 54.8 35.5 90.3
Range of motion of shoulders and hips 3.2 45.2 51.6 96.8Physical exam for active sacroiliitis e.g. Patrick test 12.9 35.5 51.6 87.1
Physical exam for redness or swelling of eyes 0.0 38.7 61.3 100.0
ESR 0.0 41.9 58.1 100.0
CRP 0.0 45.2 54.8 100.0
> 50% used in clinical practice > 70%