A panel of experts in SpA was selected, comprising (1) all the members of the ASAS who were native Spanish speakers, and resident in Spanish-speaking countries, along with other members of the ASAS, who were also native Spanish speakers, who worked in countries which were not Spanish speaking; (2) the members of the Group committee for the study of Spondyloarthritis from the Spanish Society of Rheumatology (GRESSER for its initials in Spanish). Two methodologists and one documentalist also collaborated, and guidance was given by 2 linguists from the Real Academia Nacional de Medicina de España (RANM). The opinion of patients from the Spanish Coordinator of Spondylitis Associations (CEADE) was also provided. In total, the work group comprised 29 participants from 5 different countries (one from Argentina, one from Chile, 2 from Colombia, 22 from Spain and 3 from Mexico).

Firstly a review was made of the scope of the literature (following a similar pattern to that used in a systematic review, but without quality assessment) which covered the last 15 years to identify the terms, abbreviations and acronyms in Spanish used in SpA (diseases, subgroups, symptoms and signs, associated manifestations, assessment variables, etc.). To do so a search was made in the different databases such as Pubmed or Embase. The terms used in Pubmed as MeSH terms were the following: “spondylitis”, “spondylarthritis”, “spondylarthropathies”, “arthritis psoriatic”, “arthritis reactive” and “spondylitis, ankylosing”; as text, works in free text were: “espondiloartropatía” OR “spondyloarthritis” OR “spondyloarthritis axial” OR “espondilitis anquilopoyética” OR “espondilitis anquilosante” OR “spondyloarthritis anquilosante” OR “spondyloarthritis axial no radiográfica” OR “pre-radiológica” OR “pre-radiográfica” OR “spondyloarthritis axial pre-radiológica/pre-radiográfica” OR “artritis reactiva” OR “artritis asociada a las enfermedades inflamatorias intestinales” OR “artritis psoriásica” OR “spondyloarthritis periférica” OR “spondyloarthritis indiferenciadas” OR “espondilitis anquilosante de inicio juvenil” OR “Reiter” (using clinical queries, and free text limited to the Spanish language).

In Embase, the terms used were: spond$, “psoriasis” AND “arthritic” “psoriatic” AND “arthritis” “psoriasis” AND “arthritis” “psoriatic arthritis”/exp OR “psoriatic arthritis” limited by country of publication: Spain, Argentina, Colombia, Chile, Mexico, Bolivia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Equatorial Guinea, Honduras, Nicaragua, Panama, Paraguay, Peru, Dominican Republic, Uruguay, Venezuela. Searches were also made in different scientific societies or organisations such as the Spanish Society of Rheumatology (SER) or the Pan-American League of Associations for Rheumatology (PANLAR). The International Classification of Diseases (ICD) was also reviewed and the International Classification of Functioning (ICF), as were other related documents, such as the Panhispanic Dictionary of Medical Terms.

After review of the literature, the objectives, scope, users and sections of the document were established, together with a list of the terms, abbreviations and acronyms found in the Spanish language.

In the first Delphi round, the panel of experts were sent the list with the different options identified in the review of the literature to translate each term, abbreviation or acronym into Spanish. So as not to influence any option, when referencing any term, abbreviation or acronym, the version in English was provided, with all the different options for translating into Spanish. Regarding terms and abbreviations, each of the participants marked the ones they considered pertinent (responding yes/no and being able to select more than one option) so that they were initially taken into consideration and they could also suggest other options they considered suitable. For the acronyms, each participant specified if they considered it should be translated or not. Later, those items where at least 50% of the participants had shown they would consider them suitable and also newly suggested items, were selected. The final list included the following sections:

• i.

  A total of 75 proposals to translate 7 terms and 7 abbreviations to refer to the disease or its classification: “spondyloarthritis, axial spondyloarthritis, non-radiographic spondyloarthritis, peripheral spondyloarthritis, ankylosing spondylitis, radiographic spondyloarthritis, psoriatic arthritis, SpA, axSpA, nr-axSpA, pSpA, AS, r-SpA, PsA”.

• ii.

  A total of 14 proposals to translate 6 terms and 4 abbreviations relating to manifestations or findings relating to the disease: “enthesitis, inflammatory back pain, sacroiliitis, magnetic resonance imaging of the sacroiliac joints, bone marrow oedema, modified New York criteria, IBP, MRI-SIJ, BME, mNY”.

• iii.

  A total of 15 acronyms “ASAS, ASDAS, ASQoL, BASDAI, BASFI, BAS-G, BASMI, BASRI, MASES, MASEI, mSASSS, PsAQoL, PARS, PASI, RASS” and 7 abbreviations or special terms relating to these acronyms: “ASAS-HI, ASDAS-CI, ASDAS-MI, ASAS 5/6 improvement criteria, ASASpr, ASAS 20 response criteria and ASAS 40 response criteria”.

At this point the methodologists of the group met up with the RANM linguists to request advice. In sum, it was indicated that the decisions taken by the work group had to be adapted to the Panhispanic Dictionary of medical terms of the RANM5 and that they also had to follow the general rules contained in Table 1.

Subsequently a work group meeting was called, which took place in June 2017 in Madrid (Spain). The results of the first Delphi round were presented at this meeting (the items which met with agreement, the new suggestions and the results of the translations). Comments and recommendations by the RANM linguists were also shown, as was the information collected in the Panhispanic Dictionary of the RANM relating to the term or abbreviation under discussion. In this meeting, a consensus was reached to translate 20 of the 22 terms or abbreviations and consensual decisions were taken regarding the translation of acronyms and special terms or abbreviations linked to them.

The second Delphi round was launched with this information. In this round a vote took place between 3 options, about what the translation should be for 2 abbreviations which were the most controversial (nr-axSpA, pSpA). A proposal was also included to translate the extended form of the acronyms in section iii and each participant was requested to indicate their level of agreement (LA) with each of the proposals (from 1 to 10, with 1 being “totally disagree” and 10 “totally agree”). To accept the proposals, i.e. to establish LA, at least 70% of the participants had to vote for LA≥7.

In the second round, 3 of the acronyms did not gain a sufficient level of agreement and were therefore reformulated and voted in a third Delphi round, following the same criteria as in the second. After this third round, they all reached the minimum established level of agreement.

Finally, the results of the consensus were presented to experts in the annual ASAS meeting (January 2018, in Lisbon) for final assessment and comments.

In total, the translation for 7 terms and 7 abbreviations referring to the disease or its classification were agreed: “spondyloarthritis, axial spondyloarthritis, non-radiographic spondyloarthritis, peripheral spondyloarthritis, ankylosing spondylitis, radiographic spondyloarthritis, psoriatic arthritis, SpA, axSpA, nr-axSpA, pSpA, AS, r-SpA, PsA”.

The Spanish terms and abbreviations are contained in Table 2.

For the word which defines this group of diseases, which is spondyloarthritis in English, it was decided to use the Spanish term “spondyloarthritis”, and for its abbreviation to be “SpA” (from the English abbreviation SpA), both with a 100% LA. According to the Panhispanic Dictionary of medical terms of the RANM spondyloarthritis refers to inflammation of the intervertebral joints.6 As an observation it should be noted that the dictionary unifies the term “espondiloartropatía” but defines it as “any disease affecting vertebral joints, generally of infectious, autoimmune or degenerative origin”. Its English translation would be spondyloarthropathy. In this case the panel accepted that the term “espondiloartropatía” be used provided the author was referring to the whole group of pathologies, not when he or she was specifically referring to the inflammatory group of diseases, in which case the term to use would be “espondiloartritis”.

The next term assessed was axial spondyloarthritis, which in Spanish would be “espondyloartritis axial” (LA 100%), and its abbreviation “SpAax” (LA 72%).

For the English term ankylosing spondylitis, which is also currently known as radiographic spondyloarthritis, it was agreed that the translation should be “espondilitis anquilosante” (LA 91%), and that the abbreviation of what in English is AS and r-SpA, respectively, would be “EA” (LA 70%).

In the review of the literature, numerous synonyms were identified for ankylosing spondylitis, including Bechterew's disease, Marie-Strümpell disease, ankylopoietic spondylitis, rheumatoid spondylitis, ankylopoietic spondyloarthritis, ankylosing spondyloarthritis, Bechterew arthritis, spondylitis deformity, rhizomelic spondylitis, rhizomelic spondylosis, morbus Bechterew. Most of these are no longer in use, and the panellists advised against their usage.

It was also decided finally to use “espondiloartritis axial no radiográfica” for the English term non radiographic axial spondyloarthritis (LA 95.4%), with its abbreviation “SpAax-nr” (LA 72.2%), which in English is nr-axSpA. It should be noted at this point that the Panhispanic dictionary of the RANM emphasizes that radiographic (from radiography or related therewith) should not be confused with radiologic (from radiology or related therewith).6 The panel was totally in agreement with the term radiographic and underlined the importance of using it correctly.

Similarly the term “espondiloartritis periférica” was defined for peripheral spondyloarthritis (LA 100%), and “SpAp” as its abbreviation (LA 72.2%), the English equivalent of which is pSpA.

The most voted for term for what in English is psoriatic arthritis was “artritis psoriásica” (LA 95.4%), and its abbreviation “APs” (LA 80%) for the equivalent in English of PsA. This is the term also recommended by the panhispanic dictionary of the RANM, which also accepts other terms, such as “artropatía psoriásica”, “psoriasis artrítica” and “psoriasis artropática”, although this committee of experts advised against their usage.6

Terms and abbreviations relating to manifestations or findings specific to the disease

The translation of 6 terms and 4 abbreviations were agreed: “enthesitis, inflammatory back pain, sacroiliitis, magnetic resonance imaging of the sacroiliac joints, bone marrow oedema, modified New York criteria, IBP, MRI-SIJ, BME, mNY”. Table 2 contains a summary of the translation for these terms and abbreviations recommended by the committee of experts.

The panel unanimously agreed to use the term “entesitis”, which corresponds to the English term enthesitis. According to the Panhispanic dictionary of the RANM, enthesitis is the inflammation of one or more entheses. The dictionary also states that it is frequently used in a lax manner as if it were a synonym for enthesopathy (a term without sufficient level of agreement to be considered, and which defines other types of diseases).6 The panel wishes also to point out that often erroneous terms like “entensitis” are cited.

The term “sacroilitis” was accepted with a LA of 80.9% to refer to the inflammation of one or both sacroiliac joints. It is of note that the Panhispanic dictionary of the RANM specifies that the term “sacroileítis” is incorrect, because the term stems from “sacrum”, “ilium” and itis (inflammation). Regarding “sacroilitis” or “sacroiliitis”, both forms are accepted in the RAMN, but the form recommended by the RANM is sacroilitis (with a single “i”).6

For the following terms there were no problems with consensual acceptance because they are well established and it was only necessary to vote on the abbreviation. Thus, “DLI” was defined for “dolor lumbar inflamatorio” (LA 95.4%), in English inflammatory back pain (IBP), “RM-SI” for “resonancia magnética de articulaciones sacroilíacas” (LA 90.9%), which in English is magnetic resonance imaging of the sacroiliac joints (MRI-SI), “EMO” to refer to the term of “edema de médula ósea” (LA 86.4%), in English bone marrow oedema (BME), and “NYm” for “criterios de Nueva York modificados” (LA 77.3%), Modified New York criteria (mNY).

Since they were already highly established, it was decided not to translate any of the 15 acronyms: ASAS, ASDAS, ASQoL, BASDAI, BASFI, BAS-G, BASMI, BASRI, MASES, MASEI, mSASSS, PsAQoL, PARS, PASI, RASS. However, when referring to them in any Spanish context, it was agreed to do so in the following way: (a) the type of variable in Spanish (e.g. activity score); (b) acronym in English (e.g., ASDAS), and (c) extended form in English (e.g., Ankylosing Spondylitis Disease Activity Score). Table 3A Table 3 contains the agreed form for each one of these acronyms.

However, it was accepted that the special abbreviations o terms relating to these acronyms which usually go in front or behind them should be translated: “ASAS-HI, ASDAS-CI, ASDAS-MI, ASAS 5/6 improvement criteria, ASASpr, ASAS 20 response criteria and ASAS 40 response criteria”. Table 3B presents the specific translation of each of these terms or abbreviations.