Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Development and Validation of a Questionnaire for Evaluation of Spondyloarthritis Related Manifestations in the First Degree Relatives of Patients with Ankylosing Spondylitis.

Sharif4,  Roozbeh, Reveille6,  John D., Weisman1,  Michael H., Ward2,  Michael M., Diekman4,  Laura A., Hanumanthaiah5,  Mamatha, Assassi3,  Shervin

Cedars-Sinai Medical Center, Los Angeles, CA
NIH, NIAMS, IRP, Bethesda, MD
Univ of Texas Health Science, Houston, TX
Univ of Texas Health Science Center Houston, Houston, TX
Univ of Texas Health Science Center Houston
Univ Texas Health Sci Ctr, Houston, TX


Previous studies have shown increased frequency of spondyloarthritis (SpA) related phenotypes in the first-degree relatives (FDR) of patients with Ankylosing Spondylitis (AS). However, large scale familial aggregation studies have been hampered by difficulties in screening and diagnosis confirmation. Our goal was to develop and validate a self-administered tool to evaluate the presence of SpA manifestations in the FDRs of AS patients.


A multidisciplinary team of rheumatologists, ophthalmologists, epidemiologists, and patient focus groups were involved in the design of the questionnaire. The low back pain questions were developed in close collaboration with the CDC/NHANES 2009 group and modified for utilization as a self-administered instrument. In the validation step, family members of AS patients completed the questionnaire and were subsequently examined by a rheumatologist at the study sites. A pelvic X-ray was obtained if inflammatory back pain (IBP) symptoms were present. We compared the questionnaire (method 1) to the physician evaluation (method 2) for each SpA manifestation and for the IBP criteria by Rudwaleit. IBP was defined as presence of at least 2/4 IBP criteria in conjunction with chronic lower back pain (> 3 months) and age at symptom onset <= 50 years. The agreement and equivalency between the questionnaire and study site assessments were examined by Kappa statistics and Nam's equivalency test.


Ninety one FDRs of AS patients with mean age of 50.7 (±16.6) years were enrolled, consisting of 36 parents, 28 siblings, and 27 children. Overall, 56% of study subjects were female and 87% were Caucasians. We confirmed IBP in 27, AS in 10, Achilles' tendonitis in 25, peripheral arthropathies due to SpA in 7, uveitis in 6, psoriasis in 4, reactive arthritis (ReA) in 2 study subjects. No case of inflammatory bowel disease was reported. As shown in Table, the agreement rates ranged from 76.9% to 98.9% between two modes of acquisition. The assessment for inflammatory back pain, Achilles' tendonitis, uveitis, psoriasis and reactive arthritis showed good to very good agreement between the questionnaire and site visit results. Furthermore, the questionnaire had adequate sensitivity and specificity for all SpA manifestations except for peripheral arthritis secondary to SpA. Particularly, the sensitivity and specificity of the instrument for capturing IBP according to Rudwaleit criteria was 81.8% and 88.4%, respectively. More importantly, IBP per questionnaire had a sensitivity of 80% and specificity of 77% for AS as confirmed at the site visit.


These findings suggest that the developed questionnaire captures the SpA manifestations including AS with adequate diagnostic accuracy. This raises the possibility of utilization of this instrument for screening the FDR's of AS patients for SpA manifestations.

 AgreementExpected agreementKappaNam's test of equivalenceSensitivitySpecificity
Inflammatory back pain86.81%61.07%0.66130.08581.8%88.4%
Achilles' tendonitis/Plantar Fasciitis85.71%60.64%0.63700.02172%90.9%
Peripheral Arthritis 2nd to SpA93.26%87.40%0.46490.01642.9%97.6%
Reactive Arthritis98.90%94.56%0.79460.002100%98.9%
Low back pain screen question79.12%50.31%0.57980.314  
Morning stiffness more than 30 Minutes89.01%59.09%0.73140.073  
Improvement with Exercise but not Rest76.92%61.68%0.39770.043  
Awakening in only in 2nd Half of the Night86.81%72.44%0.52150.032  
Alternating Buttock pain90.11%76.30%0.58280.012  

To cite this abstract, please use the following information:
Sharif, Roozbeh, Reveille, John D., Weisman, Michael H., Ward, Michael M., Diekman, Laura A., Hanumanthaiah, Mamatha, et al; Development and Validation of a Questionnaire for Evaluation of Spondyloarthritis Related Manifestations in the First Degree Relatives of Patients with Ankylosing Spondylitis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :522
DOI: 10.1002/art.28291

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