Rheumatologists responded online to the MAXIMA (Management of Axial SpA International and Multicentric Approaches) survey. The objectives of this study were to compare referrals, diagnosis, and management of axial SpA in Western Europe (WE), North America (US and Canada), and the rest of world (RoW) in academic and community rheumatology practices and to identify areas for further education. Recognition, diagnosis, and management of axial spondyloarthritis (axial SpA) continue to advance. Van der Heijde, Désirée Sieper, Joachim Elewaut, Dirk Deodhar, Atul Pangan, Aileen L Dorr, Alexander P Referral patterns, diagnosis, and disease management of patients with axial spondyloarthritis: results of an international survey. No commercial use is permitted unless otherwise expressly granted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. This data-driven ASAS consensus process resulted in an ASDAS-based cut-off value defining clinically important worsening in axSpA for use in trials. The ASAS consensus was to define clinically important worsening as an increase in ASDAS of at least 0.9 points. At the second visit, 127 (10.9%) patients judged their situation as worsened.Sensitivity and specificity for an increase of at least 0.6, 0.9 and 1.1 ASDAS points to detect patient-reported worsening were 0.55 (Se) and 0.91 (Sp), 0.38 (Se) and 0.96 (Sp), and 0.33 (Se) and 0.98 (Sp), respectively. In total, 1169 patients with axSpA were analysed: 64.8% were male and had a mean age of 41.7 (SD 12.4) years. Final selection was made by a consensus and voting procedure among Assessment of SpondyloArthritis International Society (ASAS) members. Sensitivity and specificity of the three cut-offs for change in ASDAS were tested against the patient's subjective assessment of worsening as the external standard (ie, the patient reporting that he had worsened and felt a need for treatment intensification). Data necessary to calculate ASDAS were collected at two consecutive visits (spaced 7 days to 6 months). An international longitudinal prospective study evaluating stable patients with axSpA was conducted. The objective here was to select the best cut-off for ASDAS for clinically important worsening in axSpA for use in clinical trials and observational studies. In a previous phase, 12 draft definitions for clinically important worsening in axial spondyloarthritis (axSpA) were selected, of which 3 were based on absolute changes in Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP (ASDAS). Molto, Anna Gossec, Laure Meghnathi, Bhowmik Landewé, Robert B M van der Heijde, Désirée Atagunduz, Pamir Elzorkany, Bassel Kamal Akkoc, Nurullah Kiltz, Uta Gu, Jieruo Wei, James Cheng Chung Dougados, Maxime An Assessment in SpondyloArthritis International Society (ASAS)-endorsed definition of clinically important worsening in axial spondyloarthritis based on ASDAS.
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