Classification criteria for spondyloarthropathies

Abstract

Spondyloarthropathies (SpA) are a group of inflammatory arthritis which consist of ankylosing spondylitis (AS), reactive arthritis, arthritis/spondylitis associated with psoriasis (PsA), and arthritis/spondylitis associated with inflammatory bowel diseases. It is now more important than ever to diagnose and treat SpA early. New therapeutic agents including blockers of tumor necrosis factor have yielded tremendous responses not only in advanced disease but also in the early stages of the disease. Sacroiliitis on conventional radiography is the result of structural changes which may appear late in the disease process. However, magnetic resonance imaging (MRI) can visualize active inflammation at sacroiliac joints and spine in recent onset disease. The modified New York criteria, the European Spondyloarthropathy Study Group criteria and the Amor criteria do not include advanced imaging techniques like MRI which is very sensitive to the early Inflammatory changes. Assessment of SpondyloArthritis international Society has defined MRI methods for the assessment of sacroiliac joints and spine, criteria for inflammatory back pain and developed new criteria for classification of axial and peripheral spondyloarthritis. These new criteria are intended to be used for patients with SpA at the very early stage of their disease. Also, classification of psoriatic arthritis study group developed criteria for the classification of PsA. The widespread use of these criteria in clinical trials will provide evidence for a better definition of early disease and recognize many patients who may further develop classical AS or PsA. These efforts will guide therapeutic trials of potent drugs like biological agents in the early stage of these diseases.

Axial spondyloarthritis in the USA: diagnostic challenges and missed opportunities

“…These classification criteria were developed mainly to have uniform patient populations for clinical research and clinical trials; they should not be used for making the diagnosis of axSpA due to intrinsic limitations. The mNY criteria are limited by poor sensitivity and the inability to identify patients in the non-radiographic stage of disease [4,38,41]. Additionally, although ASAS classification criteria have very good sensitivity and specificity [41], there are various reasons why they should not be used for diagnostic purposes.…”

“…The mNY criteria are limited by poor sensitivity and the inability to identify patients in the non-radiographic stage of disease [4,38,41]. Additionally, although ASAS classification criteria have very good sensitivity and specificity [41], there are various reasons why they should not be used for diagnostic purposes. Specifically, certain parts of the criteria, including IBP, family history of SpA, good response to non-steroidal anti-inflammatory drugs, and the presence of enthesitis, lack objectivity and may lead to the misclassification of mechanical back pain or fibromyalgia as nr-axSpA [42].…”

Differential diagnosis of a patient with low back and toe pain

“…Inflammatory back pain (IBP) is the leading feature of SpA. 20,21 The condition often presents as low back and pelvic region pain, typically present for at least 3 months. Other common clinical features include sacroiliitis and asymmetrical arthritis that is frequently present in the lower extremities.…”

“…27 Furthermore, timely diagnosis of SpA is important as early disease management can lead to improved quality of life with appropriate intervention. 20,28,29 The purpose of this case report is to describe the differential diagnosis and management of a patient referred to physical therapy for treatment of mechanical low back pain that was eventually diagnosed as human leukocyte antigen B-27 (HLA-B27)-positive SpA.…”

Uveitis, diabetes, or cataracts? The mysterious case of the blurry left eye

“…In cases of AS, early signs include erosions on the iliac side of the joint followed by bony fusion of the sacroiliac joints, ultimately resulting in the classic "bamboo spine". At the end stage of AS, the sacroiliac joint may appear as a thin line or not be visible at all [12].…”