10. Historical look at classification criteria for axial SpA
(radiographic sacroiliitis is only REQUIRED for modified New York criteria)
1
van der Linden et al. Arthritis Rheum. 1984 Apr;27(4):361-8. 2
Amor et al. Rev Rhum Mal Osteoartic.1990 Feb;57(2):85-9.
3
Dougados et al, Arthritis Rheum. 1991 Oct;34(10):1218-27. 4
Rudwaleit et al. 2009;68:777-783.
Modified New York
criteria for AS1
1984
Amor
classification
criteria for
Spondyloarthritis2
European
Spondyloarthropathy
Study Group (ESSG)
Criteria3
1991
Assessment of
SpondyloArthritis
(ASAS) criteria for
axial Spondyloarthritis4
20091990
Incorporates Amor &
ESSG criteria
Sacroiliitis (X-ray or
MRI) Plus ≥1 SpA feature
or
HLA-B27
Plus ≥2 SpA features
Sacroiliitis (X-ray)
(required)
Plus 1 below:
Inflammatory LBP
/stiffness >3 months
Limitation of lumbar
spine motion
Limitation of chest
expansion
Scoring ≥ 6/23 points
Examples:
Good response to
NSAIDs
Expanded pain
description
Articular & extra-articular
manifestations
Genetic background
(HLA-B27, family hx)
Sacroiliitis (X-ray)
IBP or synovitis
(required)
Plus 1 below:
Enthesitis
Family hx
Psoriasis, CD, or UC
Preceding infection
Buttock pain
Sacroiliitis (X-ray)
No HLA-B27
11. The presence of subchondral bone marrow edema (BME) is
essential for defining active sacroiliitis on MRI !
STIR T1
– BME is depicted as a hyperintense signal on STIR images and usually as a hypointense signal on T1
images.
– Affected bone marrow areas are typically located periarticularly (subchondral bone marrow).
– Bone marrow edema may be associated with signs of structural damage such as sclerosis or erosions.
Rudwaleit M et al. Ann Rheum Dis 2009
33. Caloric Restriction Delays Disease
Onset and Mortality in Rhesus Monkeys
SCIENCE, 10 JULY 2009
50% of control fed animals survived as
compared with 80% of the CR animals
98.11.17 PD
41. S/P of THA t in Nov 11 2010
S/P of THA Lt in Sept 10 2010
HLA-B27: positive
CRP: 4.21--2.31--1.83--0.83--2.4--2.8
ESR: 32--12--14--15--14—15---7--18
BASDAI score: 6.2 --6.5--6.55--6.3
X ray of pelvis: Bilateral sacroilitis is suggested and that shows increased sclerosis of the bilateral sacroiliac joints with regions of irregular articular margins and narrowed joint spaces.
2. Note also joint space narrowing of the right hip joint, increased sclerosis and osteophytes of the right hip joint, and
marginal osteophytes of the lefet femoral head-neck junction. In addition, there is presence of enthesophytes of the bilateral ischial tuberosities.
3. Disk space narrowing at the L4/5 and L5/S1.
X ray of C-spine: Grade I spondylolisthesis of the C2 on C3
X ray of L-spine: Bilateral sacroilitis is suggested and that shows increased sclerosis of the bilateral sacroiliac joints with regions of
irregular articular margins and narrowed joint spaces. Ankylosing spondylitis of the L-spine.
98.11.17 07:
The ASsessment in AS (ASAS) working group together with the European League Against Rheumatism (EULAR) have developed evidence-based recommendations for the management of AS. With disease progression moving vertically from top to bottom, this figure emphasises the importance of nonpharmacological treatments throughout the course of the disease, early introduction of NSAIDs and options for refractory disease and alternatives for concomitant peripheral disease including TNF inhibitors.
Reference
Zochling J, van der Heijde D, Burgos-Vargas R, et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis. 2006;65:442-452.
X ray of pelvis: Bilateral sacroilitis is suggested and that shows increased sclerosis of the bilateral sacroiliac joints with regions of irregular articular margins and narrowed joint spaces.
2. Note also joint space narrowing of the right hip joint, increased sclerosis and osteophytes of the right hip joint, and
marginal osteophytes of the lefet femoral head-neck junction. In addition, there is presence of enthesophytes of the bilateral ischial tuberosities.
3. Disk space narrowing at the L4/5 and L5/S1.
X ray of C-spine: Grade I spondylolisthesis of the C2 on C3
X ray of L-spine: Bilateral sacroilitis is suggested and that shows increased sclerosis of the bilateral sacroiliac joints with regions of
irregular articular margins and narrowed joint spaces. Ankylosing spondylitis of the L-spine.
