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However, there is still room for improvement, aiming at reporting the complete core set and its instruments.
Implications of this thesis and future perspectives
The studies described in this thesis cover relevant aspects of the landscape of Spondyloarthritis in Colombia in terms of the performance of classification criteria, the behaviour of rheumatologists considering additional testing, as well as comorbidities and risk factors and assessment of health
status. In a field in which clinical research has been dominated by Europe, this thesis may improves the body of knowledge of a condition that has not been properly investigated in Colombia.
The confirmation of the validity of the ASAS SpA classification criteria in a South American population supports the good performance of these criteria when tested against the rheumatologist´s diagnosis. It also supports the inclusion of patients fulfilling these criteria in research studies, ensuring that the patient population is comparable to other regions of the world. This may bring research efforts in Colombia at a higher level. For clinical practice, the appropriate
selection of additional testing in patients suspected of having SpA based on clinical clues is relevant. This pre-selection of patients based on pure clinical reasoning, may help to optimize the
distribution of health resources and avoid increasing costs of diagnostic tests. This is relevant, especially in case of limited resources, which is still the reality in all Latin American countries. We strongly believe, that clinical decision making based on Bayesian principles, rather than using classification criteria inappropriately, will lead to an improvement of quality of care in clinical practice. A monitoring strategy of patients with SpA focusing on treating or avoiding comorbidities that we have established here as relevant, may guide rheumatologists to optimize treatment in their SpA patients. Moreover, the availability of an adapted version of the ASAS-HI will lead to
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