ASAS Versus Modified New York Criteria for Ankylosing Spondylitis and Axial Spondyloarthritis: Attitudes and Utilization Among Saudi Rheumatologists

Background/Objectives: Axial spondyloarthritis (axSpA) is classified using two principal systems, the modified New York (mNY) and the Assessment of SpondyloArthritis international Society (ASAS) classification criteria. Although developed for research, both are widely used in clinical practice. We assessed the self-reported use of, and attitudes toward, both criteria sets among rheumatologists in Saudi Arabia, including the perceived need for their modification. Methods: A cross-sectional online survey was conducted using a 23-item questionnaire adapted from a published multinational survey. Wilcoxon signed-rank, chi-square goodness-of-fit, and Fisher’s exact tests were applied. Results: Among 54 respondents (estimated response rate, 22%), the ASAS criteria were rated significantly more useful (mean 4.26 vs. 3.85; Wilcoxon p = 0.001) and were used more frequently (Wilcoxon p < 0.001; high use, 75.9% vs. 57.4%) than the mNY criteria. When radiographs were negative, 90.7% reported ordering sacroiliac magnetic resonance imaging (MRI). Inflammatory back pain (77.8%) and dactylitis (63.0%) were most frequently rated as “very specific”. Overall, 79.6% considered the ASAS criteria sufficiently specific for clinical trials, while 51.9% perceived a need to modify them. No statistically significant associations were detected between demographic variables and the outcomes examined. Conclusions: Respondents reported greater use of, and higher perceived usefulness for, the ASAS than the mNY criteria, a pattern that aligns directionally with multinational survey data. These self-reported findings may inform local education and future studies of how classification criteria and sacroiliac MRI are applied in practice.