Diagnostic Criteria For Ankylosing Spondylitis Research Articles

A brief human history of ankylosing spondylitis: A scoping review of pathogenesis, diagnosis, and treatment.

Background: Ankylosing spondylitis (AS) is a chronic, progressive, inflammatory disease of the spine and SI joints. Diagnostic criteria and treatments have continued to evolve, necessitating a historical compendium of AS and its management. This paper aims to review the historical context underlying the discovery of AS, as well as the major diagnostic and therapeutic discoveries in the last two centuries.Methods: A scoping review of the literature pertaining to AS was performed via the Pubmed, Scopus, and Web of Science databases. Future directions of AS treatments were assessed by querying the clinicaltrials.gov website.Results: The history of AS can be traced as far back as ancient Egypt (as evidenced by the discovery of its presence in ancient Egyptian mummies) to the late 20th century, when the inherited nature of AS was linked to a genetic factor, HLA-B27. Each discovery made throughout the years led to further investigations into the pathophysiology, diagnosis, and treatment of AS. The criteria to differentiate AS from rheumatoid arthritis were first reported in 1893. Since then, diagnostic criteria for AS have undergone a series of changes before the present-day diagnostic criteria for AS were ultimately determined in 2009 by the Assessment of Spondyloarthritis International Society.Conclusion: As the pathophysiology of AS is better understood, healthcare providers are able to diagnose and treat the condition more effectively. In particular, earlier diagnosis and multiple treatment options have facilitated efficient and more effective treatment.

Preliminary clinical study of sacroiliac activity in ankylosing spondylitis patients using quantitative dynamic contrast enhanced MRI

Objective To investigate the diagnostic values of DCE-MRI quantitative evaluation of the activity of sacroiliac joints in ankylosing spondylitis. Methods Forty two patients (36 male and 6 female) with ankylosing spondylitis in our hospital were enrolled prospectively according to the standard of diagnostic criteria for ankylosing spondylitis revised in 1984. All of them were evaluated with the blood sedimentation, C-reactive protein and ankylosing spondylitis activity index (BASDAI). We divided the patients with ankylosing spondylitis into stationary phase group and active phase group. We analyzed each of the MRI images of the two patients groups using the extended Tofts model to determine the quantitative parameters of DCE-MRI, such as contrast transfer coefficient (Ktrans) , reflux constant (Kep) , extravascular extracellular volume fraction (Ve) , plasma volume fraction (Vp). And then the differences of quantitative data between the two groups were compared. Spearman correlation analysis was performed between the parameters with statistically significant difference and BASDAI scores. Results Among the 42 patients, 22 patients (18 male and 4 female) were in active phase group and the other 20 patients (18 male and 2 female) were in stationary phase group. Ktrans, Kep, Ve were (0.750±1.130) /min, (1.008±0.732) /min, 0.460±1.735; (0.163 ± 0.401) /min, (0.505 ± 0.902) /min, 0.345 ± 3.460 for active phase group and the stationary phase group, respectively. The results of the active phase group was significantly higher than the stationary phase group (Z=3.727, 2.317, 3.696, respectively;all P 0.05). Strong correlations existed between Ktrans, Kep, Ve and BASDAI score, the correlation coefficients were 0.714, 0.430, and 0.676 (P<0.05). Conclusions Quantitative DCE-MRI parameters can evaluate the activity of the ankylosing spondylitis. Strong correlations exist between Ktrans, Kep, Ve and BASDAI score. Key words: Spondylitis, ankylosing; Magnetic resonance imaging; Sacroiliitis

Oral abstracts 1: Spondyloarthropathies * O1. Detecting axial spondyloarthritis amongst primary care back pain referrals

Background: Inflammatory back pain (IBP) is an early feature of ankylosing spondylitis (AS) and its detection offers the prospect of early diagnosis of AS. However, since back pain is very common but only a very small minority of back pain sufferers have ASpA or AS, screening of back pain sufferers for AS is problematic. In early disease radiographs are often normal so that fulfilment of diagnostic criteria for AS is impossible though a diagnosis of axial SpA can be made if MRI evidence of sacroiliitis is present. This pilot study was designed to indicate whether a cost-effective pick up rate for ASpA/early AS could be achieved by identifying adults with IBP stratified on the basis of age. Methods: Patients aged between 18 and 45 years who were referred to a hospital physiotherapy service with back pain of more than 3 months duration were assessed for IBP. All were asked to complete a questionnaire based on the Berlin IBP criteria. Those who fulfilled IBP criteria were also asked to complete a second short questionnaire enquiring about SpA comorbidities, to have a blood test for HLA-B27 and CRP level and to undergo an MRI scan of the sacroiliac joints. This was a limited scan, using STIR, diffusion-weighted, T1 and T2 sequences of the sacroiliac joints to minimize time in the scanner and cost. The study was funded by a research grant from Abbott Laboratories Ltd. Results: 50 sequential patients agreed to participate in the study and completed the IBP questionnaire. Of these 27 (54%) fulfilled criteria for IBP. Of these, 2 patients reported a history of an SpA comorbidity - 1 psoriasis; 1 ulcerative colitis - and 3 reported a family history of an SpA comorbidity - 2 psoriasis; 1 Crohn’s disease. 4 were HLA-B27 positive, though results were not available for 7. Two patients had marginally raised CRP levels (6, 10 -NR ≤ 5). 19 agreed to undergo MRI scanning of the sacroiliac joints and lumbar spine; 4 scans were abnormal, showing evidence of bilateral sacroiliitis on STIR sequences. In all cases the changes met ASAS criteria but were limited. Of these 4 patients 3 were HLA-B27 positive but none gave a personal or family history of an SpA-associated comorbidity and all had normal CRP levels. Conclusions: This was a pilot study yielding only limited conclusions. However, it is clear that: Screening of patients referred for physiotherapy for IBP is straightforward, inexpensive and quick. It appears that IBP is more prevalent in young adults than overall population data suggest so that targeting this population may be efficient. IBP questionnaires could be administered routinely during a physiotherapy assessment. HLA-B27 testing in this group of patients with IBP is a suitable screening tool. The sacroiliac joint changes identified were mild and their prognostic significance is not yet clear so that the value of early screening needs further evaluation. Disclosure statement: C.H. received research funding for this study from Abbott. A.K. received research funding for this study, and speaker and consultancy fees, from Abbott. All other authors have declared no conflicts of interest.

Audiovestibular Manifestations in Patients With Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown origin affecting up to 1% of the population. Little is known about audiovestibular impairment in patients with AS, especially the presence of cochleovestibular dysfunction in these patients. To investigate audiovestibular manifestations in AS, we studied a series of 50 consecutive patients who fulfilled the modified New York diagnostic criteria for AS and 44 matched controls. Individuals with history of cardiovascular disease, cerebrovascular complications, peripheral artery disease, renal insufficiency, syphilis, Meniere and other vestibular syndromes, infections involving the inner ear, barotrauma, or in treatment with ototoxic drugs were excluded. Most patients with AS were men (80%). The mean age at the time of study was 52.5 years, and mean age at the onset of symptoms was 34.4 years. Twenty-nine (58%) patients showed abnormal hearing loss in the audiogram compared to only 8 (18%) controls (p < 0.001). Values of audiometric tests (pure-tone average and speech reception threshold) yielded significant differences between patients and controls (p < 0.001). It is noteworthy that the audiogram shape disclosed a predominant pattern of high-frequency sensorineural hearing loss in AS patients (50%) compared to controls (18%) (p = 0.002). Also, AS patients exhibited abnormal vestibular tests more commonly than controls. AS patients had an increased frequency of head-shaking nystagmus (20%) compared to controls (0%) (p < 0.001). Moreover, patients (26%) showed a significantly increased frequency of abnormal caloric test compared to controls (0%) (p < 0.001). Finally, a significantly increased frequency of abnormal clinical test of sensory integration and balance with a predominant vestibular loss pattern was observed in patients (36%) compared to controls (5%) (p < 0.001). In conclusion, the current study demonstrates strong evidence for inner ear compromise in patients with AS.

New tools for diagnosing spondyloarthropathy

Ankylosing spondylitis (AS) in its established and early forms accounts for more than 5% of all cases of chronic low back pain. Attention has focused recently on decreasing the time from symptom onset to the diagnosis of AS, which currently ranges from five to 10 years. An earlier diagnosis would lead to improved management, in particular thanks to the recent introduction and continuing development of biotherapies, such as TNFα antagonists, and new imaging techniques, including Doppler ultrasonography and magnetic resonance imaging have proved capable of detecting early signs of AS. Biotherapies not only improve the symptoms, but may also slow or halt the progression of the inflammatory lesions before the development of radiographic changes. Current criteria for AS (New York, Amor, and ESSG) are classification criteria that provide useful diagnostic orientation in clinical practice but have inadequate sensitivity for the diagnosis of recent-onset AS. Several groups have been working on means of improving the early diagnosis of AS. An algorithm for the early diagnosis of axial AS developed by Rudwaleit et al. needs to be confirmed by prospective studies. The Assessment of SpondyloArthritis international Society (ASAS) has just issued new diagnostic criteria for AS that performed well in a large cohort of patients with recent-onset low back pain.

The High Prevalence of Subclinical Atherosclerosis in Patients With Ankylosing Spondylitis Without Clinically Evident Cardiovascular Disease

We conducted the present study to determine whether subclinical macrovascular atherosclerotic disease was present in patients with ankylosing spondylitis (AS) without clinical history of cardiovascular disease. We also sought to establish whether demographic or clinical features of the disease may influence the development of subclinical atherosclerotic disease in a series of patients with AS seen at a community hospital. We recruited 64 patients who fulfilled the modified New York diagnostic criteria for AS from Hospital Xeral-Calde, Lugo, Spain. We excluded patients seen during the recruitment period who had cardiovascular disease or renal insufficiency. We also studied 64 matched controls. Carotid artery intima-media thickness (IMT) and carotid plaques were measured in the right common carotid artery. The study was performed using high-resolution B-mode ultrasound.Patients with AS exhibited greater carotid IMT than did matched controls (mean +/- SD, 0.74 +/- 0.21 mm vs. 0.67 +/- 0.14 mm; p = 0.01; differences of means, 0.077; 95% confidence interval, 0.016-0.139). Carotid plaques were more commonly observed in patients with AS than in controls (19 [29.7%] vs. 6 [9.4%], respectively; p = 0.03). The best predictors for carotid plaques in patients with AS were erythrocyte sedimentation rate (ESR) at time of disease diagnosis (odds ratio [OR], 1.18; 95% confidence intervals [CI], 1.04-1.33; p = 0.01) and duration of disease (OR, 1.39; 95% CI, 1.01-1.92; p = 0.05). In contrast, there was no significant correlation between carotid IMT and either ESR or C-reactive protein in this study. Results of the present study show that patients with AS without clinically evident cardiovascular disease have a high prevalence of subclinical macrovascular disease in the form of increased carotid IMT and carotid plaques compared to matched controls.

HLA-B60 and B61 are strongly associated with ankylosing spondylitis in HLA-B27-negative Taiwan Chinese patients.

Carriage of HLA-B60 has been shown to increase the risk of ankylosing spondylitis (AS) in B27-positive Caucasian patients, but the association in B27-negative cases is less certain. This study assessed HLA class I gene associations in Chinese HLA-B27-negative AS patients. Forty-one Chinese HLA-B27-negative AS patients fulfilling the modified New York diagnostic criteria for AS were recruited, and 11 383 HLA-B27-negative blood donors were used for comparison. HLA-A and -B typing was done with the microlymphocytotoxicity assay. Among the B27-negative AS patients, 21 were male and 20 were female. Of HLA-B alleles, only B60 and B61 significantly increased susceptibility to AS in HLA-B27-negative patients (P<0.001). In Taiwan Chinese, carriage of B60 is increased in HLA-B27-negative AS patients. The association between B61 and HLA-B27-negative AS patients has not been reported previously. Whether the gene involved is HLA-B60 or B61 or another gene in linkage disequilibrium with these genes is unknown.

The BASDAI-D--an instrument to defining disease status in ankylosing spondylitis and related diseases

Translation and validation of the Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI) for defining disease status in ankylosing spondylitis (AS) and related diseases. The German version BASDAI-D was translated with only a few modifications. It contains six 10 cm horizontal visual analog scales to measure severity of fatigue, spinal and peripheral joint pain, tenderness and morning stiffness. A total of 318 patients with AS and other spondarthropathies completed the instrument at the beginning and at the end of their medical rehabilitation. Psychometric evaluation was performed separately for patients with AS corresponding to the modified New York Criteria ( SPA-NY, N=211) and for a second group of patients, which fulfilled the early diagnostic criteria for AS or the ESSG criteria of spondylarthropathies (Fd/Spond., N=86). SPA-NY: Factor analysis yielded one factor explaining 54.8% of variance. The sum score with a standard deviation of 1.94 is nearly symmetrical distributed with mean of 4.7. Reliability analysis yielded high internal consistency (Cronbach's alpha=0.83). Corrected item-total correlations are also high and are large ranging from 0.48 to 0.71. Concerning concordant validity the BASDAI-D showed a substantial correlation with the scale bodily pain of the SF 36 (r = -0.72). There are no correlations with objective clinical parameters. Furthermore the assessment of disease activity by the physician correlates significantly, albeit low with the BASDAI-D. Sensitivity to change yields effect sizes up to 0.60. Fd/Spond.: The results for this group are almost identical with SPA-NY (one factor explaining 53.8% variance, mean 4.6+/-1.75; corrected item-total correlations from 0.50 to 0.75; correlation with the scale bodily pain r = -0.62). Analysis for subgroups showed higher scores for women in both groups SPA-NY and Fd/Spond. BASDAI-D ist applicable for patients with AS and likewise for patients fulfilling the early diagnostic criteria for AS or the ESSG criteria of spondylarthropathies. In summary, BASDAID is reliable and valid. Because of its good acceptance and usability BASDAI-D is easy to use in research as well as in clinical practice.