Performance of classification criteria for spondyloarthritis: where do we stand in many Latin American countries? A systematic literature review and meta-analysis.

Introduction: Spondyloarthritis (SpA) encompasses a group of chronic inflammatory diseases affecting the spine and peripheral joints. Although classification criteria for SpA have been tested globally, their validity and performance in Latin American (LA) populations remain debated.

Methods: A systematic literature review was conducted following PRISMA guidelines, with the protocol registered in PROSPERO (CRD42023464861). Searches were performed in Medline, Cochrane library, Embase and Virtual Health Library databases based on the PIRO framework. Studies assessing SpA classification criteria in LA patients were included, focusing on performance characteristics. Pooled sensitivity and specificity were estimated using a proportional meta-analysis with random-effect model, followed by sensitivity analysis.

Results: Six studies met the inclusion criteria. Of the multinational studies, fewer than 10% included LA patients. Most of the studies evaluated the ASAS, the most recent criteria, and clinical diagnosis by a physician as the gold standard. The Amor criteria reported a pooled sensitivity of 71% and specificity of 46%. The ESSG criteria had a pooled sensitivity of 83% and specificity of 35%. The ASAS criteria had a pooled sensitivity of 75% and specificity of 43%.

Conclusions: These systematic literature review and meta-analysis, including SpA patients from six LA countries, suggest that the ASAS classification criteria offer the best balance for sensitivity and specificity. However, these findings highlight the need for high-quality, homogeneous studies to validate SpA classification criteria in LA populations as patient assessment continues to evolve.