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SUMARY AND DISCUSSION
The studies presented in this thesis cover many aspects related to Spondyloarthritis (SpA) in Colombia. The following topics were addressed. First, the analyses and performance of the
different SpA classification criteria and the factors important in the decision of the rheumatologist to order an MRI or HLA-B27 test in the diagnostic work-up of SpA in the context of the clinical rheumatology setting. Second, a better insight was obtained with regard to the presence of comorbidities and risk factors of patients with SpA. This included also a case-control study to
evaluate the relationship between periodontitis and SpA. Third, the translation and cross-cultural adaptation to Spanish of the ASAS-HI was performed. Finally, the implementation of the domains and instruments of the ASAS core set in clinical trials have been evaluated.
In this final chapter, we summarize the main findings of the studies included in this thesis. In addition, we will discuss the potential unmet needs in the field of rheumatology in Colombia and we propose a research agenda for the upcoming years.
In the first study presented in this thesis, the performance of the various classification criteria developed for SpA (ESSG, Amor and ASAS criteria) was tested in a clinical practice cohort of patients
in Colombia. Patients with a clinical diagnosis of SpA (defined as the reference standard) were analysed for the various characteristics included in these classification criteria in chapter 2. In this cohort, the ASAS criteria were most sensitive in classifying patients having SpA in comparison to ESSG and Amor criteria. Even, the addition of MRI did not substantially increase the classification rate of ESSG and Amor criteria. Similar findings with regard to the validity of the ASAS criteria using the clinical diagnosis as reference have been reported in the European SPACE cohort 1. In both studies, a substantial rate of concordance with regard to the different criteria sets was observed.
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