Classification Criteria For Axial Spondyloarthritis Research Articles

Scanning of the Sacroiliac Joint and Entheses by Color Doppler Ultrasonography in Patients with Ankylosing Spondylitis

To assess Doppler ultrasonography by comparing its detection of sacroiliitis with detection of enthesitis in patients with ankylosing spondylitis (AS). One hundred sixty-one patients with AS (according to modified New York criteria or Spondyloarthritis International Society classification criteria for axial spondyloarthritis) underwent ultrasonography (US) of the sacroiliac joint (SIJ) and major entheses of the lower limbs. Vascularization of the SIJ and morphologic changes and vascularization of entheses were observed. The resistive index of the SIJ was measured. Doppler ultrasonography examination was repeated in 20 patients by another ultrasonographer. In the AS active group [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥ 4], 90.7% of SIJ showed vascularization; this was significantly more than in the inactive group (38.5%). The resistive index of the active group in the SIJ area was significantly lower than that of the inactive group. Doppler US scanning of the SIJ was more sensitive (92.0%) than that of the entheses (52.2%). Agreement of Doppler US scanning of the SIJ and BASDAI was good, while agreement of the entheses and BASDAI was poor. Lower resistive index value and vascularization in the SIJ had good agreement with AS activity. Doppler US is more sensitive in detecting sacroiliitis than in detecting enthesitis.

Sensitivity and Specificity of Magnetic Resonance Imaging for Axial Spondyloarthritis

Diagnosing spondyloarthritis (SpA) early in young patients with inflammatory back pain and normal findings on radiographs of the sacroiliac joints (SIJ) remains a challenge in routine practice. Magnetic resonance imaging (MRi) is regarded as the most sensitive imaging modality for detecting early SpA before the radiographic appearance of structural lesions. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRi demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least 1 clinical feature of SpA. A systematic and standardized evaluation of the SIJ in patients with SpA showed that MRI has much greater diagnostic utility than documented previously and allowed a data-driven definition of a positive MRI for SpA. Single MRI lesions suggestive of inflammation can be found in the SIJ and the spine in up to one quarter of healthy controls and young patients with mechanical back pain.

Recently diagnosed axial spondyloarthritis: gender differences and factors related to delay in diagnosis

A cohort of patients with recently diagnosed axial spondyloarthritis (SpA) was characterized with emphasis on gender differences and factors leading to delay in diagnosis. Clinical, laboratory, and imaging data of 151 consecutive patients diagnosed with ankylosing spondylitis or undifferentiated SpA in 2004-2009 and satisfying the new ASAS classification criteria for axial SpA, was collected and analyzed. Seventy-nine men and 72 women were enrolled. Both groups (men and women) had similar age of onset of disease-related symptoms, as well as similar delay time to diagnosis, follow-up duration and frequency of anti-TNF treatment. Inflammatory back pain, as a first symptom related to SpA, was reported more often by men, while women had more pelvic, heel, and widespread pain (WP) during the course of the disease. At the time of diagnosis, men were more limited in chest expansion and showed increased occiput-to-wall distance compared to women. Elevated erythrocyte sedimentation rate and/or C-reactive protein were detected in a similar proportion of men and women. Presence of WP in women almost doubled the delay in the diagnosis of SpA. No other differences in disease presentation or burden were demonstrated to correlate with delay in diagnosis.

Justification for including MRI as a tool in the diagnosis of axial SpA

New classification criteria for axial spondyloarthritis (SpA) have been developed and validated. MRI of the sacroiliac joints is an important feature in these criteria. This is rightfully so, as MRI can identify active lesions in the subchondral bone marrow that are thought to be related to the underlying pathophysiological process at the cartilage-bone junction. Follow-up studies using various imaging techniques, including MRI, in unselected patients with undiagnosed back pain of short symptom duration will provide more information on the differential diagnostic capacity of MRI and its predictive value for long-term outcomes. Even longer-term follow-up (>10 years) is necessary to provide reliable data; however, the validity of MRI in the diagnostic process can only be approximated, as it will never cover the entire gestalt of SpA.

Early axial spondyloarthritis

To summarize recent advances in the classification of preradiographic axial spondyloarthritis (SpA). Inflammation in the sacroiliac joints precedes radiographic damage that is necessary to establish a diagnosis of ankylosing spondylitis (AS). Preradiographic axial SpA refers to patients with SpA who exhibit signs and symptoms of axial involvement, but lack criteria for AS. Patients with axial SpA can have remarkably similar clinical features and disease activity as those with early AS. MRI is a sensitive method for detecting sacroiliac joint inflammation, which is useful in predicting the development of AS. Whole-body MRI has emerged as a means to visualize additional areas of involvement. However, it may be less sensitive than conventional MRI, and thus its added value will need to be further assessed. The incorporation of MRI evaluation of the sacroiliac joints and HLA-B27 testing into criteria for identifying individuals with preradiographic axial disease has led to the development of criteria for classifying axial SpA. The development of classification criteria for axial SpA will aid in the identification of patients suitable for clinical trials testing whether early intervention will slow the development and/or progression of structural changes in that lead to AS.

New approaches to diagnosis and classification of axial and peripheral spondyloarthritis

Ankylosing spondylitis (AS) is characterized by inflammatory back pain, impaired spinal mobility, and sacroiliitis on radiographs. The diagnostic delay in AS of several years is mainly attributable to the late appearance of definite sacroiliitis on radiographs. Efforts have been made in recent years to improve and standardize making an early diagnosis. MRI can visualize sacroiliitis in patients with typical symptoms of AS, that is inflammatory back pain, but yet normal radiographs of the sacroiliac joints, and has evolved as the most important diagnostic imaging tool in early disease, also referred to as nonradiographic axial spondyloarthritis (SpA). Both human leukocyte antigen-B27 and sacroiliitis on MRI play a major role in the recently proposed diagnostic algorithm which is meant to be applied in individual patients as well as in the new Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axial SpA. Most recently, ASAS has also developed new criteria for peripheral SpA. The new ASAS criteria for axial SpA will facilitate the conduct of clinical trials and other studies in early axial SpA and will help establishing a diagnosis. Yet, they should not be misused as diagnostic criteria. The new criteria for peripheral SpA may better reflect the current view on peripheral SpA.

Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group

Background:Magnetic resonance imaging (MRI) of sacroiliac joints has evolved as the most relevant imaging modality for diagnosis and classification of early axial spondyloarthritis (SpA) including early ankylosing spondylitis.Objectives:To identify and...

The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection

Objective:To validate and refine two sets of candidate criteria for the classification/diagnosis of axial spondyloarthritis (SpA).Methods:All Assessment of SpondyloArthritis international Society (ASAS) members were invited to include consecutively new patients...

The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal

Objective:Non-radiographic axial spondyloarthritis (SpA) is characterised by a lack of definitive radiographic sacroiliitis and is considered an early stage of ankylosing spondylitis. The objective of this study was to develop...